C-Reactive Protein, Immature to total Neutrophil Ratio and Micro ESR in early diagnosis of Neonatal Sepsis

Prutha Pankajkumar Desai,Tejas Pandya,Tejal Pandya,Pankaj Desai,Amrish N Shah

doi:10.7439/ijbar.v5i8.830

Prutha Pankajkumar Desai, Tejas Pandya + Show 3 more

Open Access

https://doi.org/10.7439/ijbar.v5i8.830

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Abstract

Neonatal Sepsis is a clinical syndrome characterized by signs and symptoms of infection, identified & confirmed by positive blood cultures. As per National Neonatal Perinatal Database (NNPD) 2002-2003, the incidence of neonatal sepsis in India was 30 per 1000 live birth.Systemic bacterial infection is known by the term neonatal sepsis which incorporates septicemia, pneumonia and meningitis. C-reactive protein (CRP), an acute phase reactant has advantages of low serum levels in normal infants, a rapid rise after 12 to 24 hours of sepsis and a massive rise thereafter as long as inflammatory stimuli persist and followed by immediate fall of serum level as soon as inflammation subside. Micro ESR can be compared to wintrobe’s method of doing ESR and can be used in neonatal sepsis. Rates do not vary considerably with gestational age, birth weight, but are inversely related to hematocrit level, Particularly when it is less than 40 mm/dl. The micro ESR is generally mildly elevated in non infectious conditions. In most of the patients with infection the micro ESR is elevated within 24 hours of infection and it is not influenced by antibiotic. It is well-known fact that understanding hematology of neonatal sepsis helps in early identification of suspected cases of neonatal sepsis. Amongst Hematological parameters Immature to total neutrophil( I:T) ratio has a reasonably good predictive value for early diagnosis of neonatal septicemia. This study is done as an endeavor to add to something about our preexisting knowledge of ‘diagnosis of neonatal sepsis’ early for better management of this group of patients

Highlights

Neonatal Sepsis is a clinical syndrome characterized by signs and symptoms of infection, identified & confirmed by positive b lood cultures.[1]
Three groups of neonates were taken for the study: (A) Proven sepsis: Patients with obvious clinical course of neonatal septicemia that were blood culture positive. (B) Most probable sepsis: Patients with obvious clinical course of neonatal septicemia but were blood culture negative. (C) No sepsis: Healthy infants without any signs and symptoms of septicemia
The high incidence of neonatal septicemia in premature babies is due to many factors but mainly due to diminished resistance because of fragile skin, poor cilliary action, defective chemotaxis etc

Summary

Introduction

Neonatal Sepsis is a clinical syndrome characterized by signs and symptoms of infection, identified & confirmed by positive b lood cultures.[1]. I ts advantages include its very low serum levels in normal infants, a rapid rise after 12 to 24 hours of sepsis and a massive rise thereafter as long as inflammatory stimuli persist and followed by immediate fall of serum level as soon as inflammation subside make it suitable for diagnosis and foll ow up of neonatal sepsis.[2,4] Still it has some limitation like rise of level is evident after 12-24hr of infection and there is some false positive results in case of intraventricular haemmorhage, meconium aspiration, NEC (necrotizing enterocolitis), pneumothorax, surgery, immunization etc 2,4 .It is wellknown fact that understanding hematology of neonatal sepsis helps in early identification of suspected cases of neonatal sepsis, predicting the prognosis and helps in decision of line of treatment to these neonates as to have better outcome[6]. Various hematological parameters have already been studied like ANC (absolute neutrophil count), I: T ratio (immature to total granulocyte ratio) , Micro ESR, Band cell count, Thrombocytopenia etc. but test are either subjective or become positive in late stage. 1.1 Aims and objectives: To evaluate the diagnostic efficacy of the following parameters alone or in combination in the early diagnosis of neonatal se pticemia, so that immediate treatment can be started before results of bacterial culture (The gold standard confirmatory test) become available

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