To Evaluate Diagnostic Efficacy of Nucleated Red Blood Cells (NRBCs) in Neonatal Sepsis

Abstract

BACKGROUND 
 Early diagnosis of sepsis in neonates is cardinal. The isolation of the organism from the body fluids is time-consuming and does not reliably exclude the infection even if it is negative. Nucleated red blood cells (NRBCs) are immature erythrocytes that are elevated in association with foetal distress, hypoxia, and inflammation. The purpose of the study was to evaluate the diagnostic efficacy of nucleated red blood cells (NRBCs) in the detection of neonatal sepsis.
 METHODS 
 This was a prospective study which was conducted in the section of haematology, Department of Pathology of Shri Guru Ram Rai Institute of Health and Medical Sciences, Dehradun, Uttarakhand. A total of 92 term neonates admitted to NICU with clinical features and risk factors of sepsis from October 2020 to March 2021 were included in the study. All study neonates were classified into proven sepsis, probable clinical sepsis and no sepsis groups. The NRBC count and haematological parameters were obtained by a fully automated analyzer SYSMEX XN1000 and corroborated with a peripheral blood smear. The data obtained were analyzed using one-way ANOVA with Fisher’s LSD multiple comparison tests or t-test using GraphPad Prism 7 software. A P-value of 0.001 was taken to be statistically significant.
 RESULTS
 Among the 92 cases studied, 23 were culture-positive sepsis, 31 were of probable clinical sepsis or were culture-negative and the rest 38 cases had no sepsis. In the present study, the difference in NRBC count between the sepsis and no sepsis group was statistically significant (P-value < 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of NRBC count for sepsis were found to be 77. 78 %, 60.52 %, 73.68 % and 65.71 % respectively. The average NRBC count in the mortality group was higher than in live neonates.
 CONCLUSIONS 
 The NRBC count showed comparable or higher sensitivity than haematological parameters. Higher NRBC counts in the mortality group correlated with adverse neonatal outcomes, hence carrying a prognostic value.