Rapid identification of neonatal sepsis

Abstract

Objective: To achieve rapid identification of neonatal sepsis.

Setting: Neonatal Intensive care unit (NICU) of a teaching hospital.

Method: We evaluated fifty neonates who were admitted with clinical features suggesting sepsis or who had principal risk factors, e.g. Prematurity (< 36 weeks), Low birth weight (< 2.5 kg), H/o maternal pyrexia or prolonged rupture of membranes, birth asphyxia, unbooked cases or instrumentation. Five tests, i.e., Total Leukocyte Count (T.L.C.), Absolute Neutrophil Count, Immature/Total Neutrophil ratio (I.T. ratio), Platelet count and C-Reactive protein were used for rapid diagnosis of neonatal sepsis.

Results: C-reactive protein (C.R.P.) and absolute Neutrophil count had a sensitivity of over 60% with a specificity of 50%. White blood cell count had a specificity of 93% but a sensitivity of 14%.

Conclusion: None of the tests used alone were reliable, but when in combination these five tests may help to diagnose sepsis within a few hours. Also, if the tests show a high negative predictive value, the neonate can be discharged early from the hospital, stopping the antibiotics, thereby reducing the cost of treatment and anxiety of the family.