Changes in the differential white blood cell count in screening for Group B streptococcal sepsis

Interpreting Complete Blood Counts Soon After Birth in Newborns at Risk for Sepsis

“…[3][4][5]12 Our fifth and 50th percentiles closely match those for term infants reported by Schmutz et al, 12 who used a similar design by using data systems at Intermountain Health care. Our finding that the test characteristics of the CBC improve with age is in agreement with studies that reveal poor performance of the CBC when it is used primarily in young (<4 hours old) infants, 5,7,[19][20][21] including some who specifically show improvement with later CBCs. 19,20 Our study has important limitations.…”

“…Our finding that the test characteristics of the CBC improve with age is in agreement with studies that reveal poor performance of the CBC when it is used primarily in young (<4 hours old) infants, 5,7,[19][20][21] including some who specifically show improvement with later CBCs. 19,20 Our study has important limitations. First, this is a study of early-onset sepsis in term and late-preterm infants.…”

Role of Guidelines on Length of Therapy in Chorioamnionitis and Neonatal Sepsis

“…Both the IT ratio and CRP have a high negative predictive value for neonatal infections. 4,10,11,15,16 Therefore, if either the IT ratio or CRP is normal at 6 to 12 hours of life, the likelihood of having an infection is very low. In our cohort, 14.9% of infants had an abnormal IT ratio and 22% of infants had an abnormal CRP finding at 12 hours of age.…”

Can Fullterm and Nearterm Infants at Risk for Sepsis be Managed Safely Without Antibiotics?

“…Although this has been recommended as the single test needed to identify infected infants, the result may also be normal in the septic newborn, especially if the sample is drawn within the first 24 hours of life. 9 The normal maximum reference value for the I/T ratio during the first day of life is 0.16, 10 but investigators have reported I/T ratios of Ն0.22 in noninfected infants with other illnesses. 11 The CRP has also been used to diagnose neonatal sepsis.…”

“…Sepsis screens employing various combinations of laboratory tests have been used in an attempt to improve reliability. 3,7,9 One study reports a hematologic scoring system that was developed in an attempt to improve the diagnostic accuracy of the complete WBC. 3 In this study a score of 1 was assigned for each abnormal finding of the following seven laboratory studies: total leukocyte count, total neutrophil count, immature neutrophil count, I/T ratio, immature to mature neutrophil ratio, platelet count, and degenerative morphologic changes in polymorphonuclear cells.…”