Neutrophil-to-Lymphocyte Ratio as an Alternative Marker of Neonatal Sepsis in Developing Countries

Abstract

Objectives: We sought to analyze the neutrophil-to-lymphocyte ratio (NLR) as an alternative marker of neonatal sepsis. Methods: In this cross-sectional study, we undertook consecutive sampling in all inborn neonates admitted to the Neonatal Intensive Care Unit with clinical manifestations of neonatal sepsis. Neonates with congenital anomalies and referred neonates were excluded. Complete blood count, C-reactive protein (CRP), and blood culture were carried out as the septic workup examinations based on the local Clinical Practical Guidelines. NLR is obtained by dividing the absolute count of neutrophils from lymphocytes manually. A cut-off value of NLR is obtained using a receiver operating characteristic curve. Results: The median NLR value of the 104 neonates who met the inclusion and exclusion criteria was 3.63 (2.39–6.12). Neonates with NLR of 2.12 have the area under the curve of 0.630 (95% confidence interval (CI): 0.528–0.741) and 0.725 (95% CI: 0.636–0.814) when combined with CRP = 2.70 mg/dL. Neonates with NLR ≥ 2.12 in clinical neotnatal sepsis had almost double the risk of providing positive blood culture results (relative risk = 1.867, 95% CI: 1.077–3.235; p =0.011). Conclusions: NLR, calculated from complete blood count, can be used as an alternative marker of easy and relatively inexpensive neonatal sepsis, especially in developing countries, and detection of proven neonatal sepsis to be better when combined with CRP.

The Utility of the Neutrophil-Lymphocyte Ratio as an Early Diagnostic Marker in Neonatal Sepsis

“…This finding is incongruous to Sucilathangam et al, where they found that 85% of culture-positive neonates had a normal WBC count [11]. Similarly, Sumitro et al reported in their study that around 90% of septic neonates had a WBC count within the normal range [12]. In two multicentric studies, the WBC count and ANC count were studied, and they did not perform well as a standalone diagnostic tool for early-onset neonatal sepsis in late-preterm and term neonates.…”

“…Babies who presented within the first 72 hours of birth with signs of sepsis were diagnosed as early-onset sepsis while those who presented later were classified as late-onset sepsis. In a similar kind of study population from Indonesia, the median NLR value of septic neonates 3.63 was higher compared to an NLR of 2.12 in the suspected sepsis group, with an AUC of 0.63 [12].…”

Diagnostic Values of Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio in the Early Diagnosis of Early-Onset Neonatal Sepsis in Full-term Newborns

“…Table [3] shows that Klebsiella was the most common organism in blood culture [20%] followed by E. coli and group B streptococci [13.3%].…”

“…As for the time of symptoms onset, they are categorized as Early-Onset Sepsis [EOS] and Late-Onset Sepsis [LOS]. In case the neonate is presented with clinical signs and inflammation with increase in the biomarker, but the blood culture is negative, then sepsis is defined as clinical Sepsis [3,4] .…”

Validation of Hematological Markers in Early Onset Neonatal Sepsis

“…Neonatal sepsis is a major issue to deal with worldwide and contributes to significant morbidity and mortality, especially in developing countries with an incidence of 10-50 per 1000 live births [ 7 ]. India has the highest incidence of sepsis (17,000/1,00,000 live births), with the case fatality rate of neonatal sepsis ranging between 25% to 65% [ 8 ].…”