Evaluation of efficacy of septic screen in diagnosis of early onset sepsis

Abstract

Background: Clinical features of sepsis are non-specific in all neonates and a high index of suspicion is required for the timely diagnosis of sepsis. Although blood culture is the gold standard for the diagnosis of sepsis, reports are available after 48-72 h. Therefore, a practical septic screen for the diagnosis of sepsis is needed. Objectives: To study the maternal and neonatal risk factors for early onset neonatal sepsis and to evaluate the efficacy of septic screen in diagnosis of same. Methods: Total 51 inborn were selected on basis of presence of maternal and neonatal risk factors, clinical features consistent with infection. The following investigations were done: Total leukocyte count, absolute neutrophil count, immature/total Neutrophil (I/T) ratio, haematocrit, platelet count, C-reactive protein (CRP) (after 6 h), gastric lavage, Micro erythrocyte sedimentation rate (ESR), chest X-ray (after 6 h). Blood culture was sent for any neonate with septic screen positive or those developing clinical sepsis within 72 h of birth and were correlated with the gold standard test (BACTEC). Results: Our study consisted of 51 inborn babies with 61% males and 39% females, 41% preterm <37 weeks of gestation and 59% term, 64.7% low birth weight <2500 g and 33% with history of premature rupture of membrane (PROM). Amongst 51 babies, 41.2% had leucocytosis, 15.7% with leucopenia, 21.6% had thrombocytopenia and 23.9% had anaemia. 86.3% had abnormal CRP, 33.3% had abnormal Micro ESR, and 54.9% had abnormal I/T ratio. Out of 51 babies, 17 (33.3%) were culture positive. Out of 17 culture proven sepsis, 64.7% were preterm, 88.8% were LBW <2500 g and 64.7% had history of PROM. Out of 17 culture proven cases, 75% had leucopenia, 70% had abnormal I/T ratio. 58.8% had abnormal Micro ESR, 86% were CRP positive which suggest that leucopenia, CRP and Micro ESR are good septic screen markers. Gastric aspirate is less significant. Conclusion: PROM, prematurity and low birth weight, especially, very low birth weight are the common high risk factors for early onset sepsis. Amongst septic profile, leucopenia, CRP and Micro ESR are associated with culture proven sepsis.