Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Aug;31(8):799-802.
doi: 10.1097/INF.0b013e318256905c.

Use of the complete blood cell count in early-onset neonatal sepsis

Christoph P Hornik  1 , Daniel K Benjamin, Kristian C Becker, Daniel K Benjamin Jr, Jennifer Li, Reese H Clark, Michael Cohen-Wolkowiez, P Brian Smith
Affiliations

Use of the complete blood cell count in early-onset neonatal sepsis

Christoph P Hornik et al. Pediatr Infect Dis J. 2012 Aug.

Abstract

Background: Early-onset sepsis (EOS) is an important cause of morbidity and mortality in neonates, and its diagnosis remains challenging. The complete blood cell count and differential have been previously evaluated as diagnostic tools for EOS in small, single-center reports. We evaluated the diagnostic accuracy of the complete blood cell count and differential in EOS in a large, multicenter population of neonates admitted to the neonatal intensive care unit.

Methods: Using a cohort of 166,092 neonates with suspected EOS with cultures admitted to 293 neonatal intensive care units, we calculated odds ratios and receiver operating characteristic curves for complete blood cell count indices and prediction of a positive culture. We determined sensitivity, specificity and likelihood ratios for various commonly used cutoff values from the complete blood cell count.

Results: Low white blood cell counts, low absolute neutrophil counts and high immature-to-total neutrophil ratios were associated with increasing odds of infection (highest odds ratios: 5.38, 6.84 and 7.97, respectively). Specificity and negative predictive values were high (73.7%-99.9% and >99.8%). However, sensitivities were low (0.3%-54.5%) for all complete blood cell count indices analyzed.

Conclusion: Low white blood cell count, absolute neutrophil count and high immature-to-total neutrophil ratio were associated with increasing odds of infection, but no complete blood cell count-derived index possesses the sensitivity to rule out reliably EOS in neonates.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest

Christoph P. Hornik, Daniel K. Benjamin, Jennifer Li, Kristian C. Becker, and Reese H. Clark have no relevant conflicts to disclose.

Figures

FIGURE 1
FIGURE 1
Association between complete blood cell count indices and early-onset sepsis. A. WBC vintiles and ORs; B. ANC vintiles and ORs; C. I/T ratio vintiles and ORs; D. Platelet vintiles and ORs. CBC indicates complete blood cell; EOS, early-onset sepsis (≤72 hours); WBC, white blood cell; ANC, absolute neutrophil count; I/T ratio, immature-to-total neutrophil ratio; OR, odds ratio.
See this image and copyright information in PMC

References

    1. Stoll BJ, Gordon T, Korones SB, et al. Early-onset sepsis in very-low-birth-weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr. 1996;129:72–80. - PubMed
    1. Cohen-Wolkowiez M, Moran C, Benjamin DK, et al. Early- and late-onset sepsis in late preterm infants. Pediatr Infect Dis J. 2009;28:1052–1056. - PMC - PubMed
    1. Brodie SB, Sands KE, Gray JE, et al. Occurrence of nosocomial bloodstream infections in six neonatal intensive care units. Pediatr Infect Dis J. 2000;19:56–65. - PubMed
    1. Jiang JH, Chiu NC, Huang FY, et al. Neonatal sepsis in the neonatal intensive care unit: characteristics of early versus late onset. J Microbiol Immunol Infect. 2004;37:301–306. - PubMed
    1. Ng PC. Diagnostic markers of infection in neonates. Arch Dis Child Fetal Neonatal Ed. 2004;89:F229–235. - PMC - PubMed

Publication types