Early Detection Of Neonatal Sepsis Research Articles

Value of Combination of Heart Rate Observation (HeRO) Score and The Newborn Early Warning (NEW) System in Early Diagnosis of Sepsis in Preterm Infants

Abstract Background Although all newborns are at an increased risk of developing sepsis, this is particularly true for premature infants because of their immune systems haven’t fully matured. Early detection of sepsis, prior to overt clinical deterioration, would allow earlier institution of antibiotics and supportive therapies will result in better outcomes. Aim of the Work The aim of this study was to determine the effectiveness of combination of HeRO score and NEW system in early detection of neonatal sepsis in preterm infants by using HeRO score and NEW chart combined together. Methods The study included 170 preterm infants at Ain Shams Children Hospital, Cairo, Egypt: Prospective observational study. All studied neonates were subjected to NEW and HeRO scores which displayed a number or score, which represented the risk that a patient would experience clinical deterioration. Confirmation of neonatal sepsis done by withdrawal of C-reactive protein (CRP) and Blood culture. NEW system and HeRO scores followed throughout their hospital stay. The NEW system score chart divided into 3 colours (white, Amber and red). These colours used for identifying the risk for the patient. A HeRO score of 1 is “normal” for healthy preterm infants, and a score of 5 indicates a five-fold increased risk that the patient will be diagnosed with sepsis within the next 24 hours up to 5 days. Results The total number of our studied neonates were divided according to the sepsis or not into 80 neonates were sepsis free, 69 neonates who had initial sepsis and 21 who developed sepsis and NEW and HeRO scores showed statistically higher significance in patients with initial sepsis and developed sepsis than non-septic patients. NEW and HeRO score were significantly higher in septic patients than non- septic patients as cut of value of NEW and HeRO scores was >1 and >0 respectively. Conclusion The combination of HeRO score and NEW system can be used for early detection of neonatal sepsis in preterm infants.

Evaluation of haematological scoring system as a screening tool for early detection of neonatal sepsis

Background: Early diagnosis of neonatal septicemia is a vexing problem because of its nonspecific clinical picture. Hence the timely diagnosis of sepsis in neonates is critical as the illness can be rapidly progressive and, in some instances, fatal. The current study was undertaken to assess the significance of the hematological scoring system (HSS) for early detection of neonatal sepsis. Objectives were to assess the effectiveness of HSS in early detection of neonatal sepsis by comparing it with blood culture result, in neonates who were clinically suspected to have bacterial infection Methods: This is a descriptive study done in TDMCH, Vandanam for a period of 1 year. All babies who were at risk of developing sepsis were studied after applying inclusion and exclusion criteria. Blood samples were collected and subjected to sepsis work up. HSS scoring was done. Sensitivity, specificity, positive predictive value (PPV), Negative predictive value (NPV) of HSS and each of its components were calculated. Results: Among the 85 neonates studied, 39 (45.9%) were blood culture positive, 42 (49.4%) had HSS score of 5 or more. HSS score had sensitivity of 92.31%, specificity of 86.96%, PPV of 85.71% and NPV of 93.02%. Conclusions: HSS score of ≥5 had high NPV and would play a major role in ruling out neonatal sepsis.

Probiotic Use in a Randomized Controlled Trial to Prevent Sepsis and/or Necrotizing Enterocolitis in Low-Birth-Weight Infants

Neonatal sepsis is a major problem throughout the world. Early detection of neonatal sepsis is difficult because the first signs of this disease may be minimal, especially in preterm infants. The clinical signs are similar to those of non-infectious processes. Definitive blood culture results not being immediately available may prove detrimental. As a result, many babies are evaluated and treated for presumed sepsis with parenteral antibiotics while awaiting microbial isolation. This study was undertaken to evaluate the efficacy of probiotics in prevention of Late onset sepsis and or NEC in low-birth-weight babies.

Diagnostic Accuracy of Haematological Scoring System in Paired cord Blood and Peripheral Venous Blood for early Detection of Neonatal Sepsis – A Prospective Analytical Study

Introduction: Sepsis is one of the major causes of neonatal morbidity and mortality. Early recognition and diagnosis of early onset neonatal sepsis (EONS) is difficult. Hence, there is a need for early predictive screening method for EONS, for which Haematological Scoring System (HSS) is used. It comprises of total leucocyte count, immature / total neutrophil ratio, total PMN count, immature PMN count, degenerative changes in PMN and platelet count.
 Methods: 100 inborn neonates with two or more risk factors for EONS, chosen by sequential sampling method were included in this prospective analytical study. Blood samples were collected from umbilical cord and peripheral vein and analysed for haematological parameters. Blood cultures were performed as gold standard for diagnosing neonatal sepsis and sepsis screen was done to corroborate the diagnosis of EONS.
 Results: Out of 100 neonates, 21 had sepsis, 14 had probable sepsis and 65 had no sepsis. Among the variables of HSS it was observed that elevated I:T ratio, thrombocytopenia, elevated I:M ratio and elevated immature neutrophil count have shown significant correlation with EONS with statistically significant p values (p value < 0.05), with raised I:T ratio being highly sensitive in identifying neonatal sepsis and degenerative changes in neutrophils being highly specific.
 Conclusions: The HSS was found to be satisfactory in identifying EONS. It can be used as a simple, quick, cost effective and readily available screening test with decent sensitivity and high specificity, for detection of EONS.

Blood Biomarkers of Neonatal Sepsis with Special Emphasis on the Monocyte Distribution Width Value as an Early Sepsis Index.

Background and Objectives: Early detection of neonatal sepsis is critical because it is potentially fatal. Therefore, sepsis biomarkers of sufficient sensitivity and specificity are needed. This study aimed to evaluate the utility of peripheral blood parameters as neonatal sepsis biomarkers and the diagnostic performance of the monocyte distribution width (MDW) in sepsis in a neonatal intensive care unit. Materials and Methods: A cross-sectional study was conducted from September 2019 to August 2020 at the King Saud University Medical City in Riyadh, Saudi Arabia. Samples were collected and organised as follows: 77 study cases were subdivided into two subgroups (other health complication (49) and sepsis (28)), and there were 70 controls. The causative microorganisms of neonatal sepsis were isolated. Peripheral blood samples were collected from each neonate in an ethylenediaminetetraacetic acid tube for a complete blood count and a leukocyte differential count. Moreover, the receiver operating characteristic (ROC) curve analysis was used to measure the diagnostic performance of the MDW. Results: The haematological parameters and neonatal sepsis cases had a considerable correlation. The MDW was the most significant haematological parameter. The ROC analysis of the MDW demonstrated that the area under the curve was 0.89 (95% confidence interval: 0.867 to 0.998) with a sensitivity of 89.3%, a specificity of 88.2%, and a negative predictive value of 97.2% at the cut-off point of 23. Conclusions: The use of haematological parameters is feasible and can be performed rapidly. Neonatal sepsis showed a strong correlation with leukopenia, anaemia, thrombocytopenia, and an elevated MDW value. Moreover, the ROC curve analysis confirmed the high diagnostic ability of the MDW in neonatal sepsis prediction.

Sensitivity and Specificity of C-Reactive Protein Against Blood Culture in Patients with Neonatal Sepsis - A Hospital-Based Study

Background: Neonatal septicemia is one of the primary causes of disease and death in low-income countries which makes early diagnosis an important factor to prevent microbial resistance and initiate antibiotic therapy. C-reactive protein is an essential biological indicator that might play an important role in the early detection of neonatal sepsis. Objective: The present study was conducted to determine the sensitivity and specificity of CRP against blood culture in the identification of neonatal sepsis. Methods: This study was carried out on 416 neonates identified with sepsis at the NICU and SICU of the National Institute of Child Health, Karachi, Pakistan for a span of 06 months from April 2022 to September 2022. The first blood sample for the evaluation of CRP and blood culture was drawn at the time of admission. The second sample of CRP and blood culture was drawn 72 hours after the first blood collection. The sensitivity and specificity of CRP were calculated on both occasions. Results: Of the total 416 neonates, 165(39.6 %) patients’ blood culture was positive and in 273 (65.9%) patients CRP was positive. The validation study of CRP in the diagnosis of neonatal septicemia reported sensitivity, specificity, positive predictive value, and negative predictive value to be 87.1%, 45.9%, 52.6%, and 83.7% 72 hours after the admission in comparison to 80.6%, 44.2%, 48.7%, and 77.6% at the time of admission. Conclusion: The high specificity and sensitivity of CRP against blood culture make it an important diagnostic modality that might play a helpful role in the diagnosis of neonatal sepsis.

The Value of Perinatal Factors, Blood Biomarkers and Microbiological Colonization Screening in Predicting Neonatal Sepsis.

Background: Neonatal sepsis is one of the most important causes of elevated morbidity and mortality rates in neonatal intensive care units worldwide. While the clinical manifestations of neonatal sepsis tend to be nonspecific, its rapid development and life-threatening potential call for reliable markers for early detection. Methods: We conducted a retrospective single-center study including all neonates suspected of having developed neonatal sepsis from 2013 to 2016. Perinatal and clinical characteristics as well as microbiological and laboratory findings were evaluated. Neonatal sepsis was defined as either culture-proven sepsis (positive blood culture) or clinical sepsis (at least one symptom and elevated C-reactive protein (CRP) concentrations within 72 h with negative blood culture). We further differentiated between early-onset (EOS) and late-onset (LOS) sepsis. Results: Microbiological colonization screening by throat and rectal swabs frequently did not detect the organism that subsequently caused the sepsis. Depending on the age of the newborn with sepsis (EOS or LOS), associations between different anamnestic and clinical factors (prenatal or postnatal ones) were found. In particular, the central–peripheral temperature difference showed a strong association with LOS. Laboratory results useful for the early detection of neonatal sepsis included interleukin-6 (IL-6) and CRP concentrations. Conclusions: Elevated IL-6 >100 ng/L was a strong marker for neonatal sepsis. When choosing the antibiotics for treatment, data from microbiological colonization screening should be considered but not solely relied on. Some indicators of infection also depended on postnatal age.

Evolution of Heart Rate Complexity Indices in the Early Detection of Neonatal Sepsis.

Despite advances in prenatal health care, neonatal sepsis remains a major cause of neonatal mortality. Early diagnosis and adequate treatment are essential to reduce morbidity and mortality related to this disease. In this paper, we propose a new method to detect neonatal sepsis based on heart rate (HR) complexity measures (entropy and compression indices) that takes into consideration neonatal gestational age. First, the percentile curves were computed for all the complexity indices using data from 118 control neonates. Eight indices were computed: the sample entropy (SampEn) and three indices to quantify the multiscale entropy (MSE) curve - the sum, the slope, and the product of the previous two - and the compression ratio (CR), using the bzip2 compressor, as well as the same three indices but related to the multiscale compression (MSC) curve. Then, the corresponding percentile was estimated for 23 sepsis neonates. Results show a significant decrease in the entropy indices SampEn and MSEsum and in the MSCslope a day before the detection of sepsis by the clinicians. The indices CR and MSCsum increased before the antibiotic take. These results imply that sepsis causes a random, uncorrelated pattern on the HR signal. Future studies should include a bigger data set to calculate a compound index comprising information of other physiological signals. Clinical Relevance - Prompt and accurate diagnosis of neona-tal sepsis is essential for the successful clinical management of neonates and significantly reduce morbidity and mortality. Complexity measures applied to the HR time series appear to detect sepsis in neonates starting one day before the clinical detection.

Diagnostic utility of combined immature and total neutrophil counts along with C-reactive protein in early detection of neonatal sepsis: A cross-sectional study

IntroductionA timely diagnosis is critical for management of Neonatal sepsis. Blood Culture is considered to be the “Gold Standard” for its diagnosis, but it has some limitations. In recent times, highly sensitive and specific inflammatory markers like interleukins, ELISA, counter immune-electrophoresis etc. have been in use for its diagnosis. But these are impractical for developing countries, due to their high cost and requirement of sophisticated equipments. A combination of haematological parameters like total leucocyte count (TLC), immature to total neutrophil ratio (I/T ratio), absolute neutrophil count (ANC), platelet count and C-reactive protein (CRP) estimation provide an early diagnosis of bacteremia. This study was undertaken to evaluate the usefulness of the above mentioned parameters as indicators for early diagnosis of neonatal sepsis. Material and methodsIn the present cross-sectional study, we intent to analyse various hematologic parameters in 160 neonates admitted in the neonatal care unit of a tertiary care hospital in Delhi. We obtained data from the records of blood culture and complete blood counts of neonates from pathology and microbiology departments of the hospital. Out of 160 admitted neonates, 80 were taken as cases and remaining 80 were taken as controls. Medical records were studied to identify infants born at ≥ 34 weeks gestation. CBCs was analysed, blood cultures and CRP were done in department of Microbiology. CBC, CRP and Blood culture was done as per standard protocols and clinical assesment by paediatrician. The statistical analyses were performed using SPSS version 22 for windows. ResultsAmong 80 neonates, who were in early neonatal sepsis, 44 cases (55%) were females, and 36 (45%) were males. The Microbiological profile of 80 septic neonates was analysed. The I/T value, ANC and CRP values were significantly higher in the neonates suffering from sepsis as compared to the control group. Among 80 septic neonates (cases), 30 (37.5%) were having normal ANC while 50 (62.5%) were having increased ANC and 34 (42.5%) were having normal I:T ratio while 46 (57.5%) were having increased I:T ratio. Out of 80 septic neonates (cases), 18 (22.5%) were having normal CRP while 62 (77.5%) were having increased CRP. ConclusionANC, I/T Ratio and CRP are quick, simple and cost-effective routine laboratory tests which help in early diagnosis of neonatal sepsis. Although there are many serological markers available, ANC and I/T Ratio serves as a reliable predictor of neonatal sepsis. With a good sensitivity, high specificity and a good negative predictive value these parameters can therefore help in timely and early identification of neonatal sepsis.

Re-visiting micro ESR as a screening tool for neonatal sepsis.

Our study evaluated the role of micro-erythrocte sedimentation rate (micro-ESR) in the early detection of neonatal sepsis.Neonates with >34 completed weeks of gestation, appropriate for gestational age, admitted in our Neonatal Intensive Care Unit with clinical suspicion of early onset sepsis were enrolled in the study. A sepsis screen and blood culture was performed on all the babies within 4 h of admission. The sensitivity of micro-ESR for detecting positive blood culture was calculated and the best cut-off was determined using the Area Under Curve.

Preterm Infant with Respiratory Distress, Hypotonia, and Hypoglycemia.

Preterm Infant with Respiratory Distress, Hypotonia, and Hypoglycemia.

Diagnostic Evaluation of Hematological Sepsis Score and Presepsin in Neonatal Sepsis

Background: Early detection of neonatal sepsis and categorization of patients based on clinical severity is not yet effectively achieved. Some hematological parameters are used to formulate a hematological scoring system (HSS) and a modified hematological scoring system (MHSS) to diagnose neonatal sepsis. A promising biomarker: Presepsin, or Soluble Cluster of Differentiation 14 SubType (sCD14-ST), is a proteolysis product of CD14 produced after immune activation during infections. The purpose of this research is to assess the performance of both hematological sepsis scores and serum presepsin level in neonatal sepsis and compare them to C-reactive protein (CRP) as diagnostic tools and predictors of mortality.
 Materials and Methods: This case-control study comprised two groups, one group comprised 51 neonates who were further subgrouped into suspected & proved sepsis, along with 30 uninfected neonates as the control group. Both groups were subjected to the calculation of HSS and MHSS, serum presepsin levels, CRP measurement, and blood culture and assessed for clinical severity and mortality.
 Results: Hematological sepsis scores and presepsin levels were significantly higher in the sepsis group (P <0.001). Presepsin showed the best diagnostic performance at > 0.5 ng/ml (AUC 0.979; sensitivity of 94.1% and specificity of 100%). While HSS and MHSS at a cutoff value > 1 achieved comparable specificity, lower sensitivity, 72.6% for the former and 76.5% for the later was noted. Presepsin also was significantly higher in the dead group (P<0.004) with the best predictive performance over CRP at cutoff value >1.9 ng/ml (AUC 0.838; sensitivity of 85.7% and specificity of 79.6%).
 Conclusion: Hematological sepsis scores and presepsin were useful diagnostic tools in neonatal sepsis, with presepsin as a good predictor of mortality comparable to CRP.

Estimating the Diagnostic Accuracy of High Sensitive C- Reactive Protein (hs-CRP) in Early Detection of Neonatal Sepsis

Background: Neonatal sepsis is a critical issue and if sepsis in neonates is diagnosed early by reliable tests, we can avoid unwanted administration of higher antibiotics, reduce the expenses of hospital care and also prevent emergence of bacterial strains that are resistance to antibiotics. Detecting neonatal sepsis in its earlier stage is still difficult as it presents as a variety of symptoms that could also classify many other disorders. Early onset sepsis presents within 72 hours of birth. This study aims to measure the efficacy of high sensitive CRP (hs-CRP) in early diagnosis of neonatal sepsis.
 Methodology: This prospective cross sectional study will be conducted at AVBRH, Wardha. Two serial measurements of hs-CRP will be taken and values will be correlated with respect to other conventional screening markers. CRP and hs-CRP levels in these populations will be studied and compared to assess sensitivity, specificity and observed cut off values for the same. The neonates will be followed up during hospital stay till discharge and outcome will be noted and all data will be collected. Data analysis will be done at the end using appropriate statistical methods.
 Expected Results: In our study we expect hs-CRP to be more sensitive in predicting neonatal sepsis as compared to conventional markers like CRP, Septic screen. We expect hs-CRP to be a better predictor in diagnosing sepsis so that we can intervene early and reduce morbidity and hospital stay.
 Conclusion: Inclusion of hs-CRP as part of routine screening of neonates for sepsis can be recommended.

Validity of eosinophil count and monocyte-lymphocyte ratio for early detection of neonatal sepsis

Background: Sepsis is a major cause of mortality in neonatal. Diagnosing neonatal sepsis is a challenge, as its clinical symptoms are not specific. Various studies have been conducted to identify infection markers for early identification of neonatal sepsis, but none have shown satisfactory results. Therefore, we aimed to determine the validity of eosinophil count and monocyte lymphocyte ratio (MLR) for the early detection of neonatal sepsis. Objective: To determine the validity of eosinophil count and monocyte lymphocyte ratio (MLR) for the early detection of neonatal sepsis. Methods: This study was a retrospective study with a diagnostic test. Data were collected from medical records of neonates with early-onset neonatal sepsis (EONS) or clinically EONS who were admitted to Neonatal Ward in Sanglah Hospital between April 2020 and December 2020. The ROC curve was used to determine the cut-off point of eosinophil count and MLR. Furthermore, a chi-squared test was used to determine sensitivity, specificity, PPV, and NPV Results: The total sample was 100 subjects, and 28 subjects had positive blood culture (28%). The eosinophil count (cut-off of 0.16x103/µL or 160 cell/mm3) produced a sensitivity of 57.14%, specificity of 65.28%, PPV of 39.02%, and NPV of 79.66%. At a cut-off value of 0.38, MLR had a sensitivity of 67.86%, specificity of 72.22%, PPV of 48.72%, and NPV of 85.25%. Conclusion: Children with obesity were found to be significantly related to elevated blood pressure (hypertension).

Validity of eosinophil count and monocyte-lymphocyte ratio for early detection of neonatal sepsis

Validity of eosinophil count and monocyte-lymphocyte ratio for early detection of neonatal sepsis

MATERNAL C-REACTIVE PROTEIN IN PREGNANCY AND ITS RELATION WITH EARLY ONSET NEONATAL SEPSIS

Objective:To determine association of early-onset neonatal sepsis (EONS) in newborns of serum C-reactive protein positive mothers.
 Study Design: Cross sectional study
 Place and duration of study: Department of Pediatrics, Combined Military Hospital Quetta, Pakistan from September 2016 to March 2018.
 Material and Methods: 105 neonates (both gender) of all mothers who were C - reactive protein positive were enrolled in this study using inclusion and exclusion criteria.Neonatal sepsis was diagnosed by clinical examination, which was carried out by senior pediatrician, blood complete picture and c reactive protein. Neonates were treated as per departmental protocol. Stratification was done in regard to gestational age, birth weight and age of neonates in hours. Post stratification chi square test was applied and p-value less than 0.05 was considered significant.
 Results:Out of total 105 patients, 46 (44%) were male and 59 (56%)were female neonates. Amongst the babies of 105 CRP positive mothers, 79 babies were having signs and symptoms of neonatal sepsis and 26 babies were having no signs and symptoms of neonatal sepsis with statistically significant relation between maternal CRP and neonatal sepsis of p value <0.05.
 Conclusion:Increased maternal CRP level is associated with increased risk of neonatal sepsis. Maternal CRP may be used as a good screening tool for early detection of neonatal sepsis.

Diagnostic Markers for Early Detection of Neonatal Sepsis

Background: Neonatal sepsis (NS) is a major health problem throughout the world. The diagnosis of sepsis is challenging due to the non-specific nature of the clinical presentation, the variety of other neonatal disorders with the differential diagnostic workup, lack of sensitivity and specificity of available diagnostic procedures, and the delay in the results of blood cultures in addition to high negative results reported. The diagnosis of suspected sepsis has to be based on clinical symptoms together with biochemical parameters. A diagnostic marker with high diagnostic sensitivity and specificity would be a valuable tool for decreasing the burden of neonatal sepsis Purpose: Evaluate the validity of interleukin-6 (IL-6) in the early diagnosis of neonatal sepsis or the use of a combination of diagnostic markers, C-reactive protein (CRP), and IL-6. Methods: The study included 30 patients with NS (Group I) and 30 healthy newborns as control (Group II) were admitted to Neonatal Intensive Care Unit (NICU) from January 2017 to June 2017. All neonates were subjected to history taking, clinical examination, and laboratory investigations including complete blood count (CBC), blood culture and sensitivity testing, CRP, and IL-6. Results: the most causative organism of neonatal sepsis in NICU was Klebsiella spp. followed by CONS. IL-6 results with cut-off value 50pg/ml, the sensitivity was 100%, the specificity was 90.32%, the positive predictive value of 90.63%, negative predictive value, and the diagnostic accuracy was 95.16. Moreover, IL-6 levels are significantly higher statistically in NS patients than controls. Conclusion: This study validated the diagnostic capability of IL-6 and showed that the combination of CRP and IL-6 as a panel for the early diagnosis of NS could enhance the sensitivity in the diagnosis of NS and may provide a new diagnostic strategy for NS patients Objective: Evaluate the validity of interleukin-6 (IL-6) in early diagnosis of neonatal sepsis or the use of combination of diagnostic markers, C-reactive protein (CRP) and IL-6. Patients and methods: The study included 30 patients with NS (Group I) and 30 apparently healthy newborns as control (Group II) were admitted to Neonatal Intensive Care Unit (NICU) from January 2017 to June 2017. All neonates were subjected to history taking, clinical examination, and laboratory investigations including: complete blood count (CBC), blood culture and sensitivity testing, CRP, and IL-6. Results: the most causative organism of neonatal sepsis in NICU was klebsiella spp. followed by CONS. IL-6 results with cut-off value 50pg/ml, the sensitivity was 100%, the specificity was 90.32%, positive predictive value of 90.63%, negative predictive value, and the diagnostic accuracy was 95.16. Moreover, IL-6 levels are significant higher statistically in NS patients than controls. Conclusion: This study validated the diagnostic capability of IL-6 and showed that the combination of CRP and IL-6 as a panel for the early diagnosis of NS could enhance the sensitivity in the diagnosis of NS and may provide a new diagnostic strategy for NS patients.

Study the role of c-reactive protein and thrombocytopenia in diagnosing early neonatal sepsis

Background: In clinical practice, early detection of neonatal sepsis remains difficult. Neonatal sepsis diagnosis is a challenge because of its non-specific presentation and the low sensitivity of the time-consuming bacterial cultures. So, many sepsis markers, like C-reactive protein (CRP) and platelet count, are emerging to improve its diagnosis. The aim of the study was to evaluate the role of CRP and platelet count in early neonatal sepsisMethods: This study was conducted in the department of SNCU in Virudhunagar Government Headquarters hospital, 50 neonates with culture-confirmed sepsis were included. Before antibiotic treatment, neonates CRP and platelet count, and other inflammatory markers were assessed.Results: In 50 newborns, culture was positive in 22 cases, CRP was positive in 24 cases, and thrombocytopenia in 18 cases. In 22 culture-positive cases, 19 cases are CRP positive, and 17 cases had thrombocytopenia. In 17 culture-positive thrombocytopenia cases, 16 cases are Gram-negative stain, 1 case is Gram-positive stain.Conclusions: CRP and Platelet can be helpful in the future diagnosis of neonatal sepsis, despite being promising and convenient markers for neonatal sepsis.

Comparison of the accuracy of some laboratory parameters with blood culture for early detection of neonatal sepsis at Zagazig university children hospital.

Comparison of the accuracy of some laboratory parameters with blood culture for early detection of neonatal sepsis at Zagazig university children hospital.

The role of Hematological Scoring System (HSS) in early diagnosis of Neonatal Sepsis

Background: Timely diagnosis of neonatal sepsis is critical. Early diagnosis of neonatal sepsis is still a great challenge. Objectives: To determine the significance of the hematological scoring system (HSS) for early detection of neonatal sepsis. Study design: A case control study done at the neonatal ICU, Al-Azhar Assiut university Hospital. It included sixty newborn infants divided into three groups (20 newborn infant for each one), septic, probably septic and control groups. Perinatal history with emphasis on risk factors for neonatal sepsis, Neonatal physical examination and laboratory investigation, including complete blood picture with differential, blood film, HSS (hematological scoring system) and blood culture. Results: HSS among septic group had a sensitivity (96%), specificity (90%), PPV (86.7%) and NPV (86%) and area under Receiver Operating Characteristic curve (ROC curve) with [95 % CI] was 0.76 (0.599 – 0.881). Immature/total WBCs ratio had a sensitivity (80.3%), specificity (78.2%), PPV (66.3%) and NPV (84.7%) in early detection of neonatal sepsis. Immature/mature WBCs ratio had a sensitivity (78.3%), specificity (66.5%), PPV (42%) and NPV (60%) in early detection of neonatal sepsis. Total leukocytic count in the septic group was statistically significantly increased compared with the corresponding values in the probable septic and control groups (P= 0.021*). Conclusions: HSS is a useful test to distinguish the infected from non-infected infants. HSS is a simple, quick, readily available effective tool with high sensitivity and specificity in the early diagnosis of neonatal sepsis.