Diagnostic value of platelet indices for neonatal bacterial sepsis

Abstract

Background Neonatal bacterial sepsis is a major cause of neonatal morbidity and mortality worldwide. Blood culture as a gold standard, as well as C reactive protein (CRP), micro erythrocyte sedimentation rate (micro ESR), white blood count (WBC), and immature-to-total (I/T) ratio as a sepsis screens are currently used methods, but their utility may be limited due to delayed reporting. Platelet indices are one of the parameters which can be helpful in the diagnosis of neonatal bacterial sepsis.
 Objective To evaluate the use of platelet indices, either alone or in combination, with other laboratory screening parameters to diagnose neonatal bacterial sepsis. 
 Methods Neonates admitted to the Neonatal Unit of RSUP Dr. Muhammad Hoesin Hospital, Palembang, South Sumatera, and showing symptoms of sepsis were included in this study. Subjects underwent testing for blood culture, sepsis screen (CRP, micro ESR, WBC, I/T ratio), and platelet indices [platelet count, mean platelet volume (MPV), and platelet distribution width (PDW)].
 Results The 107 neonates who fulfilled the inclusion criteria consisted of 42 neonates with proven bacterial sepsis (positive blood culture), 10 neonates with probable bacterial sepsis (positive sepsis screen and negative blood culture), and 55 with clinical bacterial sepsis (negative in both blood culture and sepsis screen). There were no significant differences in platelet count among the proven bacterial sepsis, probable bacterial sepsis, and clinical bacterial sepsis groups. Platelet count < 150,000/ml, PDW ³ 16.8 fL, MPV ³ 10.8 fL and combinations of the three, were highly specific markers for proven sepsis, with specificities of 92.3%, 97%, 75.4%, and 80%, respectively. However, all of these parameters were poor predictive markers for positive cultures in neonatal clinical bacterial sepsis, with sensitivities of 19%, 7.1%, 35.7%, and 23.8%, respectively.
 Conclusion Platelet indices have high specificity but low sensitivity for the prediction of proven neonatal bacterial sepsis.

Mean platelet volume (MPV) and plasma lactate level in the diagnosis and prognosis of neonatal bacteremia

“…However, another study from Indonesia conducted by Rohadi reported that among the cases group, the blood culture that yielded Gram-positive organisms over numbered the Gram negative ones. This may be attributed to lower gestational age and lower birth weight found in the culture proven sepsis group, lower number of cases group and difference in geographic distribution [10].…”

“…Neonatal sepsis is commonly diagnosed by a combination of clinical signs, nonspecific laboratory tests, and microbiologically confirmed by positive blood culture [10]. Thus, there is an eager need of a biomarker that can point out sepsis in an early stage so that appropriate management plan can be started and antibiotics can be initiated [11].…”

Diagnostic Value of Mean Platelet Volume and Platelet Distribution Width for Early-Onset Neonatal Infection

“…The results of our study agree with those of several previous studies that revealed a significant difference in the MPV and PDW of the case group compared to the control group. [8][9][10][11] In neonatal infection, platelet production climbs in response to the elevated need for coagulation activities due to endothelial damage or increased platelet destruction; thereby, larger and younger platelets are introduced into the peripheral blood. Hence, MPV and PDW values rise in acute infection.…”

“…Previous studies in other developing countries such as Tanzania and Indonesia have reported similar clinical signs of EONI. 7, 8 To minimize empiric antibiotic therapy, investigations of more specific and sensitive markers for the diagnosis of EONI have emerged and received huge attention from clinical neonatologists. Given the limited economic resources, equipment, and tests in most developing countries, finding a simple, useful, and inexpensive marker of neonatal infection is necessary.…”