939 EARLY DIAGNOSIS OF EARLY ONSET NEONATAL SEPSIS

Abstract

Early onset neonatal sepsis often presents as respiratory distress. To prospectively define the criteria for its early diagnosis, a battery of laboratory tests and duplicate blood cultures wereperformed within the first 12 hrs of life in 116 consecutive infants presented with respiratory distress. Nine infants were septic (6 with group B Streptococcus, 1 each with P. Pneumonea, E. Coli and P. Aerogenosa). There was no significant difference between septic and non septic infants in gestational age, birth weight, duration of ruptured membranes, platelet count, band count, micro sedimentation rate or roentgenographic findings. Septic infants had significantly higher incidence of positive gastric gram stains for bacteria and polymorphonuclear cells, lower white blood count (<10,000/mm3), lower absolute neutrophil count (<4500/mm3) (all p <0.05), and positive buffy coats for bacteria (4 of 4). Six of 7 infants had nitroblue tetrazolium (NBT) incorporation of >60% (normal in newborn >30%) or no neutrophils on the NBT smear. Using criteria of leuko-penia and neutropenia defined above, all septic infants would have been identified and 23% of non-septic infants would be falsely identified. Though tedious, addition of buffy coat and NBT test to the diagnostic regimen would have identified all septic infants without false identification of non septic infants. White blood count and differential is the simplest and most reliable indicator for early diagnosis of early onset sepsis of various bacterial etiologies.