Abstract
The NBT test is used as supporting evidence for the diagnosis of sepsis in children and adults. In neonates the previously observed high values in normal subjects preclude such use. Our preliminary observations on 15 healthy term newborns showed that high heparin doses gave falsely elevated NBT values; when heparin dosage was controlled (1 unit/ml NBT solution) consistent values of <20% were obtained in 68 normal infants of 25-43 wks of gestation. Since respiratory distress is a common presenting sign for both hyaline membrane disease (HMD) and neonatal sepsis, we have performed the NBT test in 25 infants with such signs to evaluate the NBT test in the differential diagnosis of HMD vs. sepsis. Endotoxin-stimulated NBT preparations were also performed to insure phagocytic inducibility of the neutrophils. NBT slides were read without knowledge of each infant's clinical diagnosis. HMD was confirmed by classical chest roengenograms and a negative rapid surfactant test in gastric aspirate, and sepsis by positive blood (4 cases) or CSF (1 case) cultures. The results were as follows: Three additional bacteremic infants had no neutrophils on the NBT smears. The NBT test appears to be a reliable indicator of neonatal sepsis and may prove beneficial in the early differentiation of HMD from bacterial infection.
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