Hematological Scoring System and its Correlation with Blood Culture, C-reactive Protein, and Micro-erythrocyte Sedimentation Rate in Early Diagnosis of Neonatal Sepsis

Abstract

BACKGROUND: Neonatal sepsis is a major health problem in our country. The cause for most of the deaths is not a failure to treat the infection, instead, it is the failure to treat it on time. Sepsis is usually identified by a gold-standard blood culture test. However, there is a need for a simple and cost-effective diagnostic tool with quick results. MATERIALS AND METHODS: A total of 70 neonates with clinical suspicion of sepsis were included in our study. The hematological parameters such as total leukocyte count(TLC), absolute neutrophil count (ANC), platelet count, immature neutrophil count, immature to total neutrophil ratio (I:T), immature to mature neutrophil ratio (I:M), toxic granules, and cytoplasmic vacuolation in neutrophil were correlated with C-reactive protein (CRP), blood culture and micro-erythrocyte sedimentation rate (micro-ESR). The performance of these hematological parameters was evaluated with the help of hematological scoring system (HSS). RESULTS: Among the hematological parameters, TLC has high sensitivity (77.8%) and specificity (72.1%), ANC has the least sensitivity (44.4%) but the highest specificity (96.7%), platelet count has high sensitivity (88.9%) but low specificity (44.3%), I:T and I:M ratio have the highest sensitivity (88.9% both), specificity (71.1% and 88.5%, respectively) and negative predictive value (91.3% and 92.8% respectively). ANC and I:M ratios have the highest positive predictive value (89.3% and 82.5%, respectively) in predicting the early diagnosis of neonatal sepsis. CONCLUSION: HSS along with CRP and micro-ESR can be used as a screening tool in neonates with clinical suspicion of sepsis as they are simple to perform, and can be done even in rural parts of the country.