Early Diagnosis Of Neonatal Septicemia Research Articles

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.

ROLE OF HEMATOLOGICAL SCORING SYSTEM IN DIAGNOSIS OF NEONATAL SEPSIS

Introduction: Neonatal sepsis is a clinical syndrome resulting from pathophysiologic effects of local and systemic infection in the 1st month of life. Septicemia usually consists of bacteremia with a constellation of signs and symptoms caused by microorganisms or their toxic products in the circulation. Neonatal sepsis was one of the common causes of neonatal mortality, contributing to 16% of all intramural deaths. Early diagnosis of neonatal septicemia is a vexing problem because of its nonspecific clinical picture. Method: This study was prospective observational study of 210 Cases received from August 2020 to August 2022 for Neonatal Sepsis. This prospective study was carried out in Department of Pathology of a tertiary care teaching hospital. The ethical permission has been obtained from Institutional Ethics Committee for conducting the study. Hemogram was obtained for each case using five part automated hematology analyser. Result: Hematological scoring system was useful test in the early diagnosis of neonatal sepsis. Diagnostic accuracy was 92.39% in this study,>=3 score was sensitive and >=4 score was specific for early diagnosis of neonatal sepsis Conclusion: The HSS increases the diagnostic accuracy of the complete blood cell count as a screening test for sepsis and simplifies and standardizes its interpretation.

Peripheral Blood Smear Can Be a Reliable and Inexpensive Alternative to Blood Culture in Early Diagnosis of Neonatal Sepsis

Background: Neonatal sepsis is one of the major causes of morbidity and mortality in newborns, more so in the developing countries. Objectives: The aim of this article is to study the role of peripheral smear, to evaluate the usefulness of white blood cell (WBC) parameters, and to establish the sensitivity and specificity of each parameter for early diagnosis of neonatal septicemia. Materials and Methods: The prospective study is of 150 neonates admitted and fulfilling the inclusion criteria, over the period of June 2019 to December 2020, and tests were performed at the Department of Pathology in a tertiary medical college and hospital. Peripheral blood sample was obtained by venipuncture and the sepsis work-up included routine blood counts and blood culture. Total leucocytes counts were counted on an automated hematology analyzer. Leishman-stained peripheral blood smears were used for the study. Results: Based on the clinical findings and laboratory data, neonates were classified into three categories: sepsis (n = 70), probable infection (n = 50), and no infection (n = 30). The blood culture reports of confirmed sepsis cases reveal the commonest organism as Escherichia coli, followed by Klebsiella, Pseudomonas, and beta-hemolytic streptococci. Abnormal I:T ratio (≥0.2) shows highest sensitivity (90%) and specificity (95%). Conclusion: The peripheral smear study is found to be very useful in the early diagnosis of neonatal septicemia as it can be performed even in a small laboratory without any special equipment and within a short period of time. Among WBC parameters, the I:T ratio shows highest sensitivity and specificity.

English

BACKGROUND Neonatal septicaemia is a bacterial infection with positive blood culture in first four weeks of life. The early sepsis screen is vital as it detects earlier and benefits the clinician to treat the infection reducing neonatal mortality and morbidity. We wanted to evaluate various haematological screening parameters and C-reactive protein (CRP) in blood culture positive neonates in sepsis. METHODS This prospective study was conducted for a period of one year. Blood samples from hundred clinically suspected neonatal septicaemia cases were subjected to aerobic culture and sepsis screen tests like C-reactive protein, erythrocyte sedimentation ratio (ESR), total WBC count, absolute neutrophil count, immature / total neutrophil count (I / T) ratio and platelet count. The culture results were correlated with the sepsis screen tests. RESULTS Of the hundred cases studied, 18 % were blood culture positive and 66 % were males. Early onset septicaemia was more common, seen in 64 % of cases than late onset septicaemia (26 %) cases. Staphylococcus aureus was the commonest organism isolated in 38.46 % of cases followed by Klebsiella pneumoniae & E. Coli. Among the haematological parameters, the positivity was best with Creactive protein (94.44 %) followed by immature & mature neutrophil ratio (I / M) (94.44 %), I / T ratio (88.88 %) and the least with absolute neutrophil count (66.0 %). Any two or more parameters were positive in 94.44 % of the subjects. CONCLUSIONS Sepsis screen has good sensitivity, specificity and is a valuable aid for early diagnosis of neonatal septicaemia. Sepsis screen is simple, cost effective, less time consuming and easy to perform. As an individual test C-reactive protein has shown highest sensitivity, specificity and is a sensitive and responsive indicator of neonatal sepsis. KEYWORDS Blood Culture, Neonatal Septicaemia, Sepsis Screen

A study to evaluate the diagnostic value investigations in early diagnosis of septicemia in newborn

Background: The early diagnosis of neonatal septicemia still poses great difficulties. Early clinical symptomatology of neonatal septicemia is mimicked by a lot of other disorders affecting the newborn. To study the diagnostic value of the combination of CRP, absolute neutrophil count, band form count to the total neutrophil ratio in early diagnosis of neonatal septicemia.Methods: A total 75 babies who got admitted to Mahavir institute of medical sciences between October 2018 to September 2019 (12) months were included in the study medical college hospital in a newborn with age less than 3 days and with well-defined maternal risk factors or clinical evidence of sepsis are included in the study. In all neonates, the blood sample was collected from a peripheral vein with all aseptic precautions, before administration of any antibiotic therapy.Results: A total 20 preterm babies (62.5%) were affected by septicemia.12 full-term babies (37.5%) were affected by septicemia. The sensitivity of a lab test is defined as the proportion of infants with proven sepsis in whom the result is abnormal. Specificity is the proportion of healthy infants in whom the result is normal.Conclusions. When both CRP and band form to mature neutrophil counts were positive the sensitivity and the negative predictive value were high compared to other combinations of two.

Biochemical and immunological markers for the early diagnosis of neonatal septicaemia

Background: Neonatal sepsis is a life-threatening condition with high mortality and morbidity throughout the world.
 Objective: This study evaluated the diagnostic role of serum procalcitonin (PCT), interleukin-6 (IL-6), tumor necrosis factor-a (TNF-a) and C-reactive protein (CRP) in the early diagnosis of neonatal sepsis.
 Methods: This cross-sectional study was conducted among neonates admitted to the special baby care unit (SCABU) of BIRDEM General Hospital, Dhaka, from November 2018 to April 2019. According to selection criteria, 90 clinically suspected cases of neonatal sepsis were selected and categorised into confirmed, probable, and no sepsis groups based on CRP, white cell count, platelet count, and blood culture results. Serum PCT, IL-6, and tumor necrosis factor (TNF-a) were estimated in all cases by standard laboratory methods.
 Results: Serum PCT, IL-6, CRP, and TNF-awere significantly higher in confirmed and probable sepsis groups in comparison to no sepsis group. Among the studied biomarkers, serum PCT was found most sensitive (95% sensitivity), and serum IL-6 was found most specific biomarkers (65.7% specificity) than CRP and TNF-a for the diagnosis of neonatal septicaemia. Though the accuracy of both PCT and IL-6 was found equal (70%), but the positive predictive value (PPV) and negative predictive value (NPV) of serum PCT were higher than IL-6.
 Conclusion: Both serum PCT and IL-6 are more sensitive and specific markers than CRP and TNF-a in the diagnosis of neonatal sepsis. Moreover, serum PCT is more useful than IL-6.
 Bangladesh Med Res Counc Bull 2020; 46(2): 83-89

Haematological Parameters in Early Diagnosis of Clinically Suspected Neonatal Septicemia

Neonatal septicemia is a life-threatening yet treatable condition. It is one of the major health problems throughout the world. Blood culture is the gold standard for diagnosis of neonatal septicemia and should be performed in all cases of suspected septicemia prior to starting antibiotics. But in the present study, the use of the haematological parameters was evaluated to determine the early diagnosis of neonatal septicemia. It was carried out in the neonatal unit of Mandalay Children’s Hospital from September 2012 to August 2013. Out of 68 cases of clinically suspected neonatal septicemia, bacterial pathogens were isolated from 33 cases. Early onset neonatal septicemia was more common than late onset. Among 33 cases of culture-proven neonatal septicemia, septicemia is not likely in 1 case (3%) while borderline for septicemia and septicemia in 6 cases (18.2%) is very likely in 26 cases (78.8%) according to haematological scoring system (HSS). HSS assigns a score of one for each of seven haematological parameters. Out of the seven haematological parameters, immature to total neutrophil ratio (I:T) and immature to mature neutrophil ratio (I:M) were the most reliable test for the neonatal septicemia. Thrombocytopenia had low sensitivity. The haematolgical parameters are simple, quick, cost effective and readily available. The sensitivity, specificity and the predictive values of haematological parameters could be enhanced by combination of these parameters rather than the use of single parameter.

Role of peripheral smear in early diagnosis of neonatal septicemia: A three-year study at tertiary care center of Saurashtra

Role of peripheral smear in early diagnosis of neonatal septicemia: A three-year study at tertiary care center of Saurashtra

Clinical study of neonatal septicemia with reference to early indicators of sepsis

Background: The use of CRP (C-reactive protein) in early diagnosis of neonatal septicemia. The usefulness of CRP in early detection of neonatal septicemia/meningitis and urinary tract infection was studied in a neonatal unit using a semi-quantitative latex-agglutination as a rapid screening method and electroimmuno assay as reference method for CRP determination.Methods: The present study was conducted among 150 patients 218 samples were taken for serum globulin determinations. Additionally, all infants born at the hospital throughout August 2016 to February 2017 with a designation of blood disease, infectious disease or tract infection (UTI) were retrospectively studied. Depending on the clinical course and therefore the results of the culture the 110 infants were divided into four groups.Results: The 110 infants in 92% of non-infected infants CRP was 16 mg/l and 80% had CRP <10 mg/l up to 3 days of age. After 3 days of age 93% had CRP <12 mg/l. The initial CRP level was increased in 9 out of 11 patients (82%) with bacterial septicemia. Low CRP was seen in one patient with total agranulocytosis and septicemia from Streptococcus type B and in one patient with Staphylococcus albus sepsis. A rise in CRP was also seen in very pre-term infants with septicemia. Increased initial CRP was uncommon in neonatal urinary tract infection (2 of 9) but a rise was seen in 3 additional patients.Conclusions: A comparison between CRP, total neutrophil blood cell count and hand neutrophil count as diagnostic parameters was in favor of CRP at this early stage of infection. CRP is of definite value as an aid in early diagnosis of neonatal septicemia and bacterial meningitis.

Assessing the Role of Clinical Manifestations and Laboratory Findings in Neonatal Sepsis

Background: Neonatal sepsis is one of the major causes of morbidity and mortality in newborns. Since early diagnosis of neonatal septicemia is important for timely initiation of correct antimicrobial therapy and considering the existence of variability in non-specific clinical laboratories, we assessed the role of clinical manifestations and laboratory findings to find the right diagnosis. Objectives: The aim of this study was to evaluate, record and rank the clinical manifestations and lab data of neonates with clinical sepsis. Methods: In a cross sectional descriptive prospective study in 2013, a total of 110 consecutive infants with clinical manifestations of sepsis were studied in two groups including early onset sepsis (EOS) taking place at 72 hours of age or younger, and late onset sepsis (LOS) occurring after 72 hours. Check list of infant’s data, presenting symptoms or signs and laboratory data in both groups were evaluated and recorded. Significant differences were set at as P < 0.05. Results: Overall, 81.8% of infants had EOS while 18.2% of infants had LOS. The mean age at the time of EOS and LOS presentation was one to two days and four to twelve days, respectively. The most common clinical manifestations were respiratory distress in 49 (44.5%), jaundice in 28 (25.5%), vomiting in 26 (23.6%) and poor feeding in 23 (20.9%) of the infants. Other clinical manifestations were lethargy (weakness), decreased sucking reflex, fever, tremor, abdominal distention and seizure, found in 12 (10.9%), 10 (9.1%), 4 (3.6%), 4 (3.6%), 3 (2.7%) and 2 (1.8%) neonates, respectively. Early Onset Sepsis was considerably associated with respiratory distress (P < 0.001), while LOS in neonates was followed by jaundice (P < 0.001), seizure (P = 0.02) and fever (P < 0.001). Anemia, leukocytopenia, leukocytosis, thrombocytopenia and C-reactive protein (CRP) positive results and blood culture was detected in 36 (32.7%), 2 (1.8%), 0 (0%), 2 (1.8%), 19 (17.3%) and 110 (100 %) neonates, respectively. Cerebrospinal Fluid (CSF) cultures were negative in all infants. Positive urine culture was seen in 10 (9.1%) infants. Conclusions: Respiratory distress is more common in EOS whereas jaundice, fever and seizure are more likely to be observed in LOS infants. Considering the results, clinical manifestations should be regarded as an important part of early diagnosis of sepsis.

Clinical Features and Haematological Indices of Neonatal Septicaemia in Poor Resource Setting

Background: The burden of neonatal septicaemia has remained high worldwide and even more severe in the developing countries like ours. Clinical manifestation is variable and non-specific thereby resulting in delay in diagnosis. Blood culture which is the gold standard for diagnosis of neonatal septicaemia (NNS) has many drawbacks due to long waiting time for culture process, low yield, improper inoculation adding to the problem of late diagnosis. Haematological parameters have been utilized in rapid and early diagnosis of NNS and prompt treatment thus circumventing problems associated with drawbacks in blood culture. Objective: The study was to identify the common clinical features of neonatal septicaemia and haematological indices that were commonly utilized in rapid diagnosis of NNS, and also to determine their sensitivity, specificity, positive predictive and negative predictive value. Materials and Methods: The study was prospective and neonates that had clinical features suggestive of neonatal septicaemia were enrolled consecutively into the study. The patients were appropriately investigated including blood cultures, CSF cultures and urine among others, also blood sample for packed cell volume (PCV), total white cell count (TWBC), absolute neutrophil count (ANC), absolute platelet count (APC). Immature to mature neutrophil ratio (I/MNR), immature to total neutrophil ratio (I/TNR) and micro-ESR (erythrocyte sedimentation rate) was also done and analyzed. Results: The common clinical symptoms were fever 39.5%, poor feeding 33.6%, excessive cry 38.7%, difficulty in breathing 50.0%, yellowish skin 26.9%, while the common physical signs were hyper/hypothermia 41.1%, tachypnoea 41.2%, septic umbilical stump 64.0%, hepatomegally 37.3% and convulsions 42.0%. Blood culture yield was positive in 41.82% and mortality was as high as 28.00%, the incidence of NNS was 5.9/1000 live births. The haematological parameters as marker of NNS PCV, TWBC, ANC, APC, I/MNR, I/TNR and micro-ESR individually were statistically significant (P < 0.05), also their individual sensitivity, specificity, positive and negative predictive values were highly associated with neonatal septicaemia. However, when they were tested in combinations these markers of neonatal septicaemia had low sensitivity, specificity and their predictive values were weak in excluding NNS. Conclusions: The need for early and rapid diagnosis of NNS is pertinent, culturing of the appropriate specimens remains the only way to identify the aetiological organisms, but is associated with delay. Haematological indices are excellent markers of NNS and analysis is rapid and can easily be done in our laboratory settings, and when utilized efficiently, it would circumvent the delay associated with blood culture for long waiting period for the result, thereby reducing morbidity and mortality.

Reappraisal of the Haematological Scoring System (HSS) for early diagnosis of neonatal sepsis in a remote geographical location of North East India

Sepsis in newborns is one of the commonest clinical problems encountered by the paediatricians. It accounts for major cases of neonatal mortality and morbidity. The initial presentation of neonatal septicaemia may be subtle and therefore, it is important not only to recognize the neonates with septicaemia but also to identify the non-infected neonates. The primary objective of the clinician caring for infants at risk for neonatal infections is to identify all potential cases of bacterial diseases quickly and begin antibiotic therapy promptly. It is important, however, to determine which of these cases represent true infection and thus require a full course of antibiotics and which do not. Blood culture is the gold standard for diagnosis, but requires 48-72 hours for the final report. It is therefore necessary to have a method for early detection of neonatal sepsis for prompt initiation of antibiotic therapy. This study is designed to evaluate the haematological scoring system put forward by Rodwell for early diagnosis of neonatal septicaemia. Keywords: Early diagnosis, Haematological scoring, Neonatal sepsis

C-Reactive Protein (CRP) in Early Diagnosis of Neonatal Septicemia

C-Reactive Protein (CRP) in Early Diagnosis of Neonatal Septicemia

Role of Serial C-reactive Protein (CRP) in Relation to Total Leucocyte Count, Platelet Count &amp; Blood Culture for early Diagnosis of Neonatal Septicemia in Developing Countries

Neonatal septicemia is a clinical syndrome of systemic illness accompanied by bacteremia occuring in the first 28 days of life. Neonatal septicemia is one of the major causes of neonatal death in developing countries. Early diagnosis and treatment can prevent neonatal mortality and morbidity. The present study includes: 1) usefulness of CRP (C-reactive protein), Total Leucocyte Count, Platelet Count and Blood Culture in early diagnosis of Neonatal Sepsis, 2) significance of serial CRP in diagnosis of neonatal sepsis. 3) the prognostic value of CRP in neonatal sepsis. This is a prospective study done in neonatal ward, Chittagong Medical College Hospital and carried out from January 2008 to January 2011. Sample size was 300. One hundred fifty neonates with suspected sepsis as cases and 150 healthy babies as control were enrolled in this study. Seventy two percent of cases neonates were preterm and low birth weight. Common risk factors for neonatal septicemia which were identified in this study; preterm (72%), low birth weight (72%), premature rupture membrane (60%), chorioamnionitis (26%) and maternal urinary tract infection (16%) . Out of 150 cases of suspected neonatal sepsis total 80.7%% had raised CRP, in initial sample 70.39% were CRP positive and in 2nd sample additional 9.31% case were CRP positive . In control group 91% were CRP negative. CRP was positive in 100% of culture proven sepsis. Sensitivity of CRP was 80.67% and specificity of CRP was 76.44%. Leucocytosis was observed in 7% of cases and leucopenia was found in 11% of cases. In 82 % cases leucocyte count was found normal. In control group, 95% had normal leucocyte count and 5% had leucocytosis but no leucopenia. Sensitivity of leucocyte count was 18% and specificity was 20.68%. Thrombocytopenia was found in 28% of case group. Out of 150 cases only 15.33% yielded growth of organisms in blood culture. Klebsiella was the most common pathogen isolated which was followed by E.coli and Strph. aureus. Sensitivity of blood culture was 15.33% and specificity was 100% Therefore serial CRP can be taken as alternative method for diagnosis of neonatal sepsis specially in developing countries where blood culture is not readily available.J Bangladesh Coll Phys Surg 2014; 32: 61-65

Role of C-Reactive Protein (CRP) as a screening tool in early diagnosis of neonatal septicemia

Background: Neonatal septicemia refers to generalized bacterial infection of neonate, which includes septicemia, pneumonia and meningitis. In developing countries one of leading factors for neonatal morbidity and mortality is bacterial sepsis. Aim: Early diagnosis of sepsis in the neonate is often difficult because symptoms and signs are usually non-specific. This study was conducted to evaluate C-reactive protein (CRP) as a screening tool for neonatal sepsis. Material and Methods: The study was conducted in Neonatal Intensive Care Unit in collaboration with Biochemistry Department at Guru Gobind Singh Medical College and Hospital, Faridkot from November 2013 to August 2014. 50 neonates were included with the age group of first 28days (4week) of life (infant age) in study. All of which were suspected to have sepsis in clinical settings. Patient with suspected sepsis having two or more of the following clinical features were used to identify patients: Respiratory and cardiovascular compromise, metabolic and neurologic changes. Blood samples were drawn prior to administration of antibiotic therapy on day one of admission for blood culture and CRP by trained staff with all aseptic precautions. Sample for blood culture was taken in blood culture bottle and the growth of bacteria was observed for 5 days after that they were reported and for CRP the investigation was performed by immunometric assay. Absolute neutrophil count and total leucocyte count was done by fully automated cell counter. Results: Among 50 septic screens, 39 (52%) patients had positive cultures, the sensitivity and specificity of ANC (Absolute Neutrophil Count) was 75% and 65.34%, TLC (Total Leucocyte Count) was 62% and 70.41%, CRP was 90 % and 83.21% respectively. This study also found that premature and low birth weight babies are more prone to neonatal sepsis. Conclusion: CRP is one of the most widely available, most studied, and most used laboratory tests for neonatal bacterial infection, and despite the continuing emergence of new infection markers, it still plays a central role in the diagnosis of early-onset sepsis of the neonate.

C-Reactive Protein, Immature to total Neutrophil Ratio and Micro ESR in early diagnosis of Neonatal Sepsis

Neonatal Sepsis is a clinical syndrome characterized by signs and symptoms of infection, identified & confirmed by positive blood cultures. As per National Neonatal Perinatal Database (NNPD) 2002-2003, the incidence of neonatal sepsis in India was 30 per 1000 live birth.Systemic bacterial infection is known by the term neonatal sepsis which incorporates septicemia, pneumonia and meningitis. C-reactive protein (CRP), an acute phase reactant has advantages of low serum levels in normal infants, a rapid rise after 12 to 24 hours of sepsis and a massive rise thereafter as long as inflammatory stimuli persist and followed by immediate fall of serum level as soon as inflammation subside. Micro ESR can be compared to wintrobe’s method of doing ESR and can be used in neonatal sepsis. Rates do not vary considerably with gestational age, birth weight, but are inversely related to hematocrit level, Particularly when it is less than 40 mm/dl. The micro ESR is generally mildly elevated in non infectious conditions. In most of the patients with infection the micro ESR is elevated within 24 hours of infection and it is not influenced by antibiotic. It is well-known fact that understanding hematology of neonatal sepsis helps in early iden­tification of suspected cases of neonatal sepsis. Amongst Hematological parameters Immature to total neutrophil( I:T) ratio has a reasonably good predictive value for early diagnosis of neonatal septicemia. This study is done as an endeavor to add to something about our preexisting knowledge of ‘diagnosis of neonatal sepsis’ early for better management of this group of patients

Role Of Serial C-reactive Protein (Crp) In Relation To Total Leucocyte Count, Platelet Count &amp; Blood Culture For Early Diagnosis Of Neonatal Septicemia In Developing Countries

Neonatal septicemia is a clinical syndrome of systemic illness accompanied by bacteremia occuring in the first 28 days of life. Neonatal septicemia is one of the major causes of neonatal death in developing countries. Early diagnosis and treatment can prevent neonatal mortality and morbidity. The present study includes: 1) usefulness of CRP (C-reactive protein), Total Leucocyte Count, Platelet Count and Blood Culture in early diagnosis of Neonatal Sepsis, 2) significance of serial CRP in diagnosis of neonatal sepsis. 3) the prognostic value of CRP in neonatal sepsis. This is a prospective study done in neonatal ward, Chittagong Medical College Hospital and carried out from January 2008 to January 2011. Sample size was 300. One hundred fifty neonates with suspected sepsis as cases and 150 healthy babies as control were enrolled in this study. Seventy two percent of cases neonates were preterm and low birth weight. Common risk factors for neonatal septicemia which were identified in this study; preterm (72%), low birth weight (72%), premature rupture membrane (60%), chorioamnionitis (26%) and maternal urinary tract infection (16%). Out of 150 cases of suspected neonatal sepsis total 80.7%% had raised CRP, in initial sample 70.39% were CRP positive and in 2nd sample additional 9.31% case were CRP positive . In control group 91% were CRP negative. CRP was positive in 100% of culture proven sepsis. Sensitivity of CRP was 80.67% and specificity of CRP was 76.44%. Leucocytosis was observed in 7% of cases and leucopenia was found in 11% of cases. In 82 % cases leucocyte count was found normal. In control group, 95% had normal leucocyte count and 5% had leucocytosis but no leucopenia. Sensitivity of leucocyte count was 18% and specificity was 20.68%. Thrombocytopenia was found in 28% of case group. Out of 150 cases only 15.33% yielded growth of organisms in blood culture. Klebsiella was the most common pathogen isolated which was followed by E.coli and Strph. aureus. Sensitivity of blood culture was 15.33% and specificity was 100% Therefore serial CRP can be taken as alternative method for diagnosis of neonatal sepsis specially in developing countries where blood culture is not readily available.&#x0D; JCMCTA 2013 ; 24 (2): 22-25

Hematologic scoring system (HSS): A guide to decide judicious use of antibiotics in neonatal septicemia in developing countries

Background: Septicemia is one of the major causes of neonatal morbidity and mortality. Objective- The objective of our study was to determine the role of hematologic scoring system (HSS) in early diagnosis of neonatal septicemia and provide an effective guideline in decision making regarding judicious use of antibiotics. Materials and Methods: The study was done taking 60 neonates admitted in the hospital. The hematological parameters were studied in all of them. Blood cultures were performed as gold standard for diagnosing septicemia. Results: Analysis of the hematologic profiles in the light of the HSS found that an abnormal immature to total neutrophil (I:T) ratio followed by an abnormal immature to mature neutrophil (I:M) ratio were the most sensitive indicators in identifying infants with sepsis. The study also found that the higher the score the greater the certainty of sepsis being present. The score ≥ 4 was more reliable as a screening tool than any individual hematological parameter.Conclusion : HSS is rapid, easy to perform, cost-effective screening tool for early diagnosis of neonatal sepsis and thereby helps in making of decisions regarding judicious use of antibiotics.

The clinical value of serum procalcitionin in the diagnosis of neonates septicemia

Objective To assess the application value of serum procalcitonin(PCT)for the differentiation between the neonates with or without septicemia.Methods PCT,C-reactive protein(CRP),blood and blood culture tests were done in 75 cases of neonatal septicemia as the therapy group,and 74 neonates without the signs of infection as the control group after the admission of our hospital One week later,the therapy group also re-examined the PTC and CRP tests.Furthermore,the results were analyzed.Results The levels of CRP(23.26±5.68)mg/L and PCT(7.61±4.53)ng/L in therapy group were dramatically reduced compared with(4.09±1.09)mg/L,(1.95±0.25)ng/L in therapy group,and(6.42±4.54)mg/L,(0.45±0.16)ng/L in the control group before therapy,the t values are 28.71,12.97 and 19.97,14.08 respectively,and p value are both less than 0.01.The positive rates of PTC,CRP and blood culture were 82.7％,48.0％ 28.0％ before the admition to hospital.The differences of PTC and CRP,PTC and blood culture had statistical significances(x2=5.64,P＜0.05;x2=10.40,P＜0.01).If 2.5 μg/L of PCT and 8mg/L of CRP would be regarded as cutoff point in our study,the sensitivity and specificity of PCT or CRP for diagnosis of neonatal septicemia was 82.7％ and 80.3％,48.7％ and 78.4％.Conclusion Our data suggested that the serum PTC is a valuable marker for the early diagnosis of neonatal septicemia. Key words: Procalcitionin; Septicemia; Infant,new born

Role of Hematologic Scoring System in Early Diagnosis of Neonatal Septicemia

Background: Neonatal septicemia is one of the major health problems throughout the world. Infections are a frequent and important cause of morbidity and mortality in neonatal period. Objective: The objective of this study was the role of hematologic scoring system (HSS) in the early diagnosis of neonatal septicemia. Methods: This is a prospective study consisted of 100 neonates admitted at neonatal ICU, BSMMU, who were clinically suspected cases of septicemia. The neonatal hematological parameter was measured in all cases. Blood culture was done for the gold standard of proven sepsis. There were 12 out of 100 neonates (12%) who had culture proven sepsis. They were predominantly preterm and of very low birth weight. Results: On evaluation of various hematological parameters total leucocytes count, total neutrophil count, IT ratio (>0.2), IM ratio (> 0.3), total immature PMNs count, platelet count were found to have optimal sensitivities and negative predictive values. Using these values hematologic scoring system was formulated according to Rodwell et al. Score > 4 has a sensitivity of 100%, specificity of 60%, with PPV 26% and NPV 100 %. Considering the high sensitivity, negative predictive value, this study implies that score > 4 were more reliable as a screening tool for sepsis than any of the individual hematological parameter. Conclusion: HSS are useful test to distinguish the infected from non infected infants. They also provide a effective guideline to make decisions regarding judicious use of antibiotic therapy. Keywords: Hematologic scoring system (HSS); Blood culture; Neonatal septicemia DOI: 10.3329/bsmmuj.v3i2.7053 BSMMU J 2010; 3(2): 62-67