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
. 2025 Jun 14;17(6):e86014.
doi: 10.7759/cureus.86014. eCollection 2025 Jun.

Significance of the Hematological Scoring System (HSS) in the Early Diagnosis of Neonatal Sepsis in a Tertiary Care Center

Rajendra Kushwaha  1 , Lal Pranay Singh  2 , Jyoti Yadav  2 , Deepshikha Verma  2
Affiliations

Significance of the Hematological Scoring System (HSS) in the Early Diagnosis of Neonatal Sepsis in a Tertiary Care Center

Rajendra Kushwaha et al. Cureus. .

Abstract

Background: Most of the neonatal mortality in developing nations is due to sepsis, making it the main cause of death in this age group. The generic characteristics of the clinical symptoms of newborn sepsis make early detection difficult. Blood culture is the gold standard for diagnosis, but it can be expensive and time-consuming, lasting several days. Another technique for the early detection of neonatal sepsis is the Hematological Scoring System (HSS), which utilizes hematologic characteristics such as leukocyte count, polymorphonuclear neutrophil (PMN) cells, immature PMN count, degenerative changes, and platelet count. The purpose of this study was to ascertain the importance of the HSS in detecting newborn sepsis early.

Materials and methods: The present study was a prospective observational study involving infants (>72 hours to 28 days of age) admitted to the Neonatal Intensive Care Unit of Gandhi Medical College and Associated Hospitals, Bhopal. This study was done in the Department of Pathology from January 2020 to June 2021. The total sample size was 153 neonates who were clinically suspected of sepsis. Hematological parameters were measured for all subjects, and each case was analyzed using the HSS.

Results: There were 112 (73.2%) males and 39 (26.8%) females in the clinically diagnosed cases of late-onset sepsis. A total of 75 (49%) of the clinically confirmed cases of septicemia had positive blood cultures. When it came to detecting newborns with sepsis, the total PMN count (74.70%) was the most sensitive, followed by the immature PMN count (65.33%). Platelet counts (61.54%) and the total leukocyte count (TLC) (92%) were highly specific assays that were useful in the diagnosis of sepsis. The immature-to-total PMN ratio (71%) came next. In order to identify infants who actually had sepsis, the total PMN ratio (89.87%) and platelet count (53%) had a significant positive predictive value for immaturity.

Conclusions: HSS is an extremely sensitive indication of sepsis. Its usage in peripheral smear tests can be a useful sepsis screening tool for early diagnosis, lowering newborn morbidity and mortality.

Keywords: blood culture; early diagnosis of sepsis; hematological scoring system; hematology; neonatal sepsis; peripheral smear; polymorphonuclear count.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethical Committee, Gandhi Medical College, Bhopal issued approval 621/MC/IEC/2020. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Distribution based on sex.
See this image and copyright information in PMC

References

    1. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Lancet. 1999;354:1955–1961. - PubMed
    1. “Neonatal sepsis”: bacteria & their susceptibility pattern towards antibiotics in neonatal intensive care unit. Sharma CM, Agrawal RP, Sharan H, Kumar B, Sharma D, Bhatia SS. J Clin Diagn Res. 2013;7:2511–2513. - PMC - PubMed
    1. Early diagnosis of neonatal infection. (Article in German) Speer CP, Gahr M, Schröter W. https://pubmed.ncbi.nlm.nih.gov/4058429/ Monatsschr Kinderheilkd. 1985;133:665–668. - PubMed
    1. Neonatal sepsis: epidemiology, clinical spectrum, recent antimicrobial agents and their antibiotic susceptibility pattern. Verma P, Berwal PK, Nagaraj N, Swami S, Jivaji P, Narayan S. Int J Contemp Pediatr. 2017;2:176–180.
    1. Changing role of neonatal sepsis markers in the era of BacT/Alert: is there a need to devise a new septic screen. Ahmad I, Ahmed A, Abrar SS, et al. Int J Contemp Pediatr. 2016;3:107–112.

LinkOut - more resources