Use of the Complete Blood Cell Count in Late-onset Neonatal Sepsis

Hornik, Christoph P.; Benjamin, Daniel K.; Becker, Kristian C.; Li, Jennifer; Clark, Reese H.; Cohen‐Wolkowiez, Michael; Smith, P. Brian

doi:10.1097/inf.0b013e31825691e4

Cited by 99 publications

(75 citation statements)

References 24 publications

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“…Differential WBC presence would be expected to modify the type of RNA recovered, but we did not identify statistically significant alterations in circulating WBCs between groups. This finding further substantiates the documented limitations of WBC and WBC indices to identify infected preterm infants (40,41). Minimal mortality in our cohort prevented meaningful comparisons between survivors and nonsurvivors.…”

Section: Discussionsupporting

confidence: 64%

Postnatal Age Is a Critical Determinant of the Neonatal Host Response to Sepsis

Wynn

Guthrie

Wong

et al. 2015

Mol Med

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Neonates manifest a unique host response to sepsis even among other children. Preterm neonates may experience sepsis soon after birth or during often-protracted birth hospitalizations as they attain physiologic maturity. We examined the transcriptome using genome-wide expression profiling on prospectively collected peripheral blood samples from infants evaluated for sepsis within 24 h after clinical presentation. Simultaneous plasma samples were examined for alterations in inflammatory mediators. Group designation (sepsis or uninfected) was determined retrospectively on the basis of clinical exam and laboratory results over the next 72 h from the time of evaluation. Unsupervised analysis showed the major node of separation between groups was timing of sepsis episode relative to birth (early, <3 d, or late, ≥3 d). Principal component analyses revealed significant differences between patients with early or late sepsis despite the presence of similar key immunologic pathway aberrations in both groups. Unique to neonates, the uninfected state and host response to sepsis is significantly affected by timing relative to birth. Future therapeutic approaches may need to be tailored to the timing of the infectious event based on postnatal age.

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Section: Discussionsupporting

confidence: 64%

Postnatal Age Is a Critical Determinant of the Neonatal Host Response to Sepsis

Wynn

Guthrie

Wong

et al. 2015

Mol Med

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“…43 High and low WBC, high Absolute Neutrophil count (ANC), high I/T ratios, and low platelet counts were associated with LOS. 44 However, a single blood cell count-derived index did not have proven sensitivity to reliably exclude EOS or LOS in neonates. 43,44 The absolute immature neutrophil count and absolute neutrophil count have suboptimal sensitivity and decreased predictive accuracy for EOS as elevation does not consistently distinguish an inflammatory response from a noninfectious etiology.…”

Section: Neutrophil Number and Functionmentioning

confidence: 99%

“…44 However, a single blood cell count-derived index did not have proven sensitivity to reliably exclude EOS or LOS in neonates. 43,44 The absolute immature neutrophil count and absolute neutrophil count have suboptimal sensitivity and decreased predictive accuracy for EOS as elevation does not consistently distinguish an inflammatory response from a noninfectious etiology. 45 The I/T ratio is a more sensitive indicator of sepsis; however, single assessments have a better negative predictive value (99%) than positive predictive value (25%).…”

Section: Neutrophil Number and Functionmentioning

confidence: 99%

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

2013

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The definition of neonatal sepsis is complicated by the frequent presence of noninfectious conditions that resemble those of sepsis, especially in very low-birth-weight (VLBW) preterm infants and by the absence of optimal diagnostic tests. Although growth of an organism from a sterile site is the "gold standard" for definitive diagnosis, it is not always possible to isolate a causative pathogen. Invasive infections can occur in seemingly asymptomatic neonates. Therefore, assessment of history and risk factors in combination with diagnostic tests are used to identify neonates who are more likely to be infected.The definitions of early onset sepsis (EOS) and late onset sepsis (LOS) are subject to subspecialist variation. Many investigators, including those who participate in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Network and the Vermont Oxford Network, define EOS by the onset of signs/symptoms and an associated positive culture at or before 72 hours of life. LOS is characterized by the onset of symptoms consistent with sepsis at greater than 72 hours of life. These classifications of EOS and LOS reflect the differing etiologies and proposed pathophysiology of pathogens commonly associated with the timing of Keywords ► neonatal sepsis ► invasive candidiasis ► epidemiology ► management AbstractIdentifying neonates with sepsis is complicated by variability in clinical presentation. The incidence of early onset sepsis (EOS) resulting from invasive group B streptococcal (GBS) infections has been notably reduced by the widespread delivery of intrapartum antibiotic prophylaxis. Rates of EOS attributable to non-GBS etiologies have remained constant, and ampicillin-resistant Escherichia coli has become more prevalent. Lateonset sepsis (LOS) attributable to gram-positive organisms including coagulase-negative Staphylococci and Staphylococcus aureus is associated with increased morbidity and mortality among premature infants. Invasive candidiasis is an emerging cause of LOS, especially among infants who receive broad-spectrum antimicrobial agents. Prophylactic fluconazole administration to very low-birth-weight (VLBW) neonates during the first 6 weeks of life prevents invasive candidiasis in neonatal intensive care units (NICU) with high rates of fungal infections. Targeted fluconazole prophylaxis may be beneficial in VLBW neonates who receive care in NICUs with lower rates of invasive fungal infections. Assessment of immune function, neutrophil markers, acute phase reactants, and utilization of sepsis screening scores may contribute to the management of sepsis. Maternal decolonization, antimicrobial stewardship, early enteral feeding, and optimal infection control practices are potential practical strategies for reducing the burden of neonatal sepsis.

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“…Apart from that, neutropenia which is very common and more sensitive in diagnosis of sepsis has a similar score as leukocytosis which is frequently seen in neonates due to non-specific reasons. 13,14 Recent recognition of role of nucleated RBCs in neonatal sepsis deserves its inclusion in diagnosis of sepsis. The modified HSS designed by us have incorporated the above facts.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have highlighted the diagnostic ability of neutropenia to be higher than leukocytosis in neonatal sepsis. 13,14 Study observed that neutropenia was strongly associated with sepsis and hence deserved a higher weightage. Hence, we increased the weightage to two (instead of one in HSS) of this parameter to obtain the modified HSS (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Modified hematological sepsis score in early diagnosis of neonatal sepsis

Krishnamurthy¹,

Thandaveshwar²,

Doreswamy³

2017

Int J Res Med Sci

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Background: Diagnosis of neonatal sepsis at an early stage substantially reduces the mortality. The clinician often relies on laboratory parameters to support the clinical suspicion. As blood culture takes time and yield is low, hematological and biochemical parameters often guide to the diagnosis and management. Rodwell’s Hematological sepsis score (HSS) has a reasonable sensitivity but low specificity. Some of the parameters included in that scoring system are repetitive of same pathogenic mechanism. A modified HSS was developed by the authors by removing the repetitive parameters, increasing the weightage for low neutrophil count and adding a new parameter - nucleated RBC. Objective of the study was to compare the diagnostic ability of the modified hematological sepsis score with Rodwell’s hematological sepsis score.Methods: Prospective analytical study conducted in a tertiary level hospital. Neonates admitted to NICU and had complete blood count done were included. Babies with clinical signs of systemic inflammatory response syndrome and evidence of organ dysfunction were considered septic. They were classified as proven sepsis if the blood culture was positive. All the samples were scored for both HSS and modified HSS. The sensitivity, specificity and other diagnostic ability tests were compared between the two scoring systems.Results: Total of 75 neonates were enrolled. 25 of them had sepsis and three had blood culture positive. At a score of 3, the sensitivity and specificity of HSS was 80 and 70% and that of Modified HSS was 84 and 82% respectively.Conclusions: Modified hematological score improves the specificity and likelihood ratios without decreasing the sensitivity in early diagnosis of neonatal sepsis.

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Use of the Complete Blood Cell Count in Late-onset Neonatal Sepsis

Cited by 99 publications

References 24 publications

Postnatal Age Is a Critical Determinant of the Neonatal Host Response to Sepsis

Postnatal Age Is a Critical Determinant of the Neonatal Host Response to Sepsis

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

Modified hematological sepsis score in early diagnosis of neonatal sepsis

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