Correlation of neonatal and maternal clinico-hematological parameters as predictors of early onset neonatal sepsis

Abstract

Neonatal sepsis is one of the major health problems throughout the world and one of the commonest causes of neonatal mortality. It accounts for 30-50% of the total neonatal deaths in developing countries. 1,2 Overall incidence of sepsis is 1-5/1000 live births and mortality rate of untreated sepsis can be as high as 50%. 3,4 In India incidence of sepsis is 38 per 1000 live births in tertiary care institutes and it contributes to 36% of deaths in ABSTRACT Background: Neonatal sepsis is one of the commonest causes of neonatal mortality and accounts for 30-50% of the total neonatal deaths in developing countries. Diagnosis of neonatal sepsis is still a great challenge since there is no single laboratory test with 100% sensitivity and specificity. Certain maternal and neonatal characteristics are predictive of Early Onset neonatal Sepsis (EOS) (onset < 72 hours of birth). The objective of this study was to evaluate the correlation of neonatal and maternal clinical and haematological manifestations with EOS and to identify the reliable specific parameters for early diagnosis of neonatal sepsis. Methods: This prospective study enrolled 95 newborns with suspected EOS and their mothers. Perinatal history, clinical profile, symptoms and laboratory data of mother and baby were recorded in each case. The neonatal sepsis screen included TLC, peripheral blood smears (PBS), DLC, ANC, I: T ratio, micro-ESR and platelet count. The maternal haematological parameters were TLC and platelet count. These parameters were evaluated based on the standard reference values. A blood culture was the standard indicator for proven sepsis. Results: Out of 95 newborns presenting with EOS, 46(48.4%) had positive blood culture. EOS was seen predominantly in preterm, males, LBW and neonates delivered vaginally. Among the various neonatal haematological parameters toxic granules, raised Micro-ESR, I/T Ratio >0.2, thrombocytopenia remained significant markers for early diagnosis of culture positive EOS (p <.05). Majority of EOS was caused by Gram negative organisms with E.Coli being the commonest. Important adverse perinatal factors associated with EOS were seen in 64.2% mothers. Maternal total leukocyte count was the most important parameter for predicting EOS in their newborns with a sensitivity of 67.2%, specificity of 77.5%, PPV of 80.4% , NPV of 63.2% though not found statistically significant (p =0.065). Conclusions: Risk factors for EOS include both maternal and neonatal factors. It is very essential to diagnose the sepsis in early phase and it is also important to rule out sepsis to prevent irrational use of antibiotics. A high index of suspicion along with simple, cost effective hematological screening parameters is sensitive and satisfactory tools in predicting early onset neonatal sepsis.

Hematological Profile of Newborns Hospitalized for Neonatal Bacterial Infection in the Neonatology of the Pediatric Department of Gabriel Toure Teaching Hospital Bamako, Mali

“…Which shows that thrombocytopenia is a sign of gravity. It is frequently associated with severe sepsis and its association with the clinical picture constitutes a poor prognosis [21] [31]. This is explained by an increased destruction of platelets by sequestration secondary to infections and/or by a decrease in production secondary to the suppression of the bone marrow.…”

“…This is explained by an increased destruction of platelets by sequestration secondary to infections and/or by a decrease in production secondary to the suppression of the bone marrow. It has a high sensitivity and specificity [21] [24] [31].…”

The effect of delivery type on neonatal blood indices in an Iranian population

“…For the first newborn, the hematological indexes (such as leukocytes, hematocrit, platelets, and hemoglobin) were higher than those for the second and third newborn. In women with high parity due to frequent childbirth and menstrual cycles, iron deficiency is greater than in nulliparous women [28][29][30] . Iron deficiency increases the risk of preterm childbirth and low weight in newborns.…”

miRNA-23b as a biomarker of culture-positive neonatal sepsis

“…Nowadays, neonatal sepsis is one of the most dangerous conditions to affect newborns during the rst 28 days of life, and is a rst-order public health system problem given its very high risk of mortality and morbidity [3,4]. It is frequently divided into two types according to onset time: early-onset sepsis (EOS), when the process develops during the rst 72 h of life; late-onset sepsis (LOS), when it occurs after the rst 72 h. Unlike to fungi and parasites, bacteria and viruses are the commonest causative agents involved in neonatal sepsis aetiology [5,6].…”