Automated Determination of Neutrophil Volume as Screening Test for Late-Onset Sepsis in Very Low Birth Infants

Abstract

W e read with interest the recent report by Haustein et al entitled "The likelihood of an indeterminate test result from a whole-blood interferon-␥ release assay for the diagnosis of Mycobacterium tuberculosis infection in children correlates with age and immune status." 1 This report adds to recent publications that question the performance of current interferon-␥ (IFN-␥) release assays (IGRA) for the diagnosis of tuberculosis (TB) in routine pediatric clinical practice. [2][3][4][5][6] The retrospective study by Haustein et al in 237 children highlights the high proportion of indeterminate test results ob-tained with the QuantiFERON-TB (QFT) Gold In-Tube assay (35% of the study population). Notably, indeterminate test results were over-represented in children younger than 5 years of age, and those with immunodeficiencies or medical conditions associated with immunosuppression. Importantly, these groups represent children most at risk for disease progression after exposure to M. tuberculosis. FIGURE 1.A, Relationship between PHA mitogen (positive) control response (censored at 15 IU/mL) and age with fitted linear regression line; (B) PHA mitogen control responses stratified by age (bars represent median values; P values were calculated by Mann-Whitney U test); (C) Proportion of indeterminate QFT assay results (ie, assays with failed PHA mitogen control response and/or high nil (negative) control combined) stratified by age ( 2 test).

Automated determination of neutrophil VCS parameters in diagnosis and treatment efficacy of neonatal sepsis

“…These parameters can be measured by the VCS technology of the Coulter LH 780 hematology analyzer (9)(10)(11)(12)(13). This so-called VCS technology is analogous to microscopic evaluation of a peripheral blood smear but evaluates more than a microscope.…”

“…This study also gives additional information about effects of sepsis onset time and birth weight on VCS parameters. Previous studies mostly included adult patients and there was only one study including newborns to diagnose late-onset neonatal sepsis (11)(12)(13)(14). Raimondi et al (2010) reported the cutoff levels of MNV and VDW as 148 au and 27.5 au in late-onset sepsis of very-lowbirth-weight infants, including 20 with proven and 20 with clinical sepsis.…”

“…Previous studies mostly included adult patients and there was only one study including newborns to diagnose late-onset neonatal sepsis (11)(12)(13)(14). Raimondi et al (2010) reported the cutoff levels of MNV and VDW as 148 au and 27.5 au in late-onset sepsis of very-lowbirth-weight infants, including 20 with proven and 20 with clinical sepsis. The sensitivity, specificity, PPV, and NPV of MNV and VDW in this study were 95, 88, 61.3, and 98.9% and 80, 52, 25, and 92.8%, respectively (13).…”

“…There is only one study in a neonatal population and it showed that MNV and VDW were useful to diagnose neonatal sepsis (13). VCS parameters seem to be promising indicators for the diagnosis of sepsis.…”

“…It has been previously reported that VCS parameters can detect morphologic changes in immature and reactive neutrophils. This so-called VCS technology is analogous to microscopic evaluation of a peripheral blood smear but evaluates more than a microscope (9)(10)(11)(12)(13).…”