DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20200228

Modified hematological sepsis score: an easy and cost effective measure to combat neonatal septicemia

Pearl Mary Varughese

Abstract


Background: Early diagnosis of neonatal sepsis continues to be a problem because of subtle and non-specific clinical features. Blood culture is the gold standard, but it takes several days and is expensive. The hematological scoring system (HSS) consisting of different blood parameters could be an effective and simple method to help diagnose and treat neonatal sepsis. Aim of the present study was undertaken to highlight the importance of HSS in the early diagnosis and evaluation of neonatal septicaemia.

Methods: This was a prospective study done in a peripheral hospital in Kerala. The inclusion criteria involved all inborn babies above 34weeks gestation. Exclusion criteria involved babies with congenital anomalies, congenital heart diseases, pathological jaundice, birth weight less than 2kg and babies requiring NICU admission, 550 babies were included in the study. Cord CRP and 48 hours CRP was taken. At 48 hours, blood samples were also taken for Total count (TC), Absolute Neutrophil Count (ANC), Platelet count, and peripheral smear. Blood culture was taken for babies suspected to have sepsis and started on antibiotics. The screening parameters were assessed for individual performance and in combination.

Results: Individually, though parameters like TC, ANC, 48 hrs CRP and platelet count had excellent sensitivity (100%) and NPV (100%), their specificity was low 65%-82%. Degenerative changes showed sensitivity 94.1%, specificity 91% and NPV 99.8%. HSS score >5 and >6 had better specificity and NPV.

Conclusions: HSS scoring can be used to safely exclude neonatal sepsis, thus avoiding unnecessary antibiotic exposure in newborns and undue worry for parents.

Keywords


Blood parameters, C-Reactive protein, Newborn, Sepsis, Septicaemia

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References


Thaver D, Zaidi AK. Burden of neonatal infections in developing countries: a review of evidence from community-based studies. Pediatr Infect Dis J. 2009 Jan 1;28(1):S3-9.

Polin RA, St Geme 3rd JW. Neonatal sepsis. Adv Pediatr Infect Dis. 1992;7:25.

Bhandari V. Effective biomarkers for diagnosis of neonatal sepsis. J Pediatr Infect Dis Soc. 2014 Jun 24;3(3):234-45.

Chiesa C, Panero A, Osborn JF, Simonetti AF, Pacifico L. Diagnosis of neonatal sepsis: a clinical and laboratory challenge. Clini Chem. 2004 Feb 1;50(2):279-87.

Paolucci M, Landini MP, Sambri V. How can the microbiologist help in diagnosing neonatal sepsis?. Inter J Pediatr. 2012 Jan 26;2012.

Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr. 1988 May 1;112(5):761-7.

Zaka-ur-Rab Z, Kar M, Gupta V, Kalra BP, Akhtar K. Evaluation of laboratory markers of sepsis screen in the diagnosis of early onset neonatal septicemia. Int J Contemp Pediatr. 2016;3:1144-9.

Narasimha A, Kumar MH. Significance of hematological scoring system (HSS) in early diagnosis of neonatal sepsis. Ind J Hematol Blood Transfusion. 2011 Mar 1;27(1):14-7.

Bhat YR, Rao A. The performance of haematological screening parameters and CRP in early onset neonatal infections. J Clini Diagnos Res. 2010 Dec 30;4(6):3331-6.

Shah BA, Padbury JF. Neonatal sepsis: an old problem with new insights. Virulence. 2014 Jan 1;5(1):170-8.

Krishnamurthy V, Thandaveshwar D, Doreswamy SM. Modified hematological sepsis score in early diagnosis of neonatal sepsis. Inter J Res Med Sci. 2017 Aug;5(8):3573.

Shiffman J. Issue attention in global health: the case of newborn survival. Lancet. 2010 Jun 5;375(9730):2045-9.

Chiesa C, Pellegrini G, Panero A, Osborn JF, Signore F, Assumma M, et al. C-reactive protein, interleukin-6, and procalcitonin in the immediate postnatal period: influence of illness severity, risk status, antenatal and perinatal complications, and infection. Clini Chem. 2003 Jan 1;49(1):60-8.

Patrick R, Rajan A, Soans ST, Shriyan A. Cord C-reactive protein as a marker for early onset neonatal sepsis children. Int J Contemp Pediatr Int J Contemp Pediatr. 2017 Mar;44(2):527-9.

Su H, Chang SS, Han CM, Wu KY, Li MC, Huang CY, et al. Inflammatory markers in cord blood or maternal serum for early detection of neonatal sepsis—a systemic review and meta-analysis. J Perinatol. 2014 Apr;34(4):268.

Arshad A, Asghar I, Tariq MA. Role of serum C-reactive protein in the rapid diagnosis of neonatal sepsis. Pak Armed Forces Med J. 2003;53:178-82.

Benitz WE, Han MY, Madan A, Ramachandra P. Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatr. 1998 Oct 1;102(4):e41-.

Ahmed Z, Ghafoor T, Waqar T, Ali S, Aziz S, Mahmud S. Diagnostic value of C-reactive protein and haematological parameters in neonatal sepsis. J Coll Physicians Surg Pak. 2005 Mar;15(3):152-6.

Chauhan S, Viren V, Bimal C. C-reactive protein in early diagnosis of neonatal septicemia. Natl J Med Res. 2012;2:276-8.

Misra RN, Jadhav SV, Ghosh P, Gandham N, Angadi K, Vyawahare C. Role of sepsis screen in the diagnosis of neonatal sepsis. Med J Dr. DY Patil University. 2013 Jul 1;6(3):254.

Dulay AT, Buhimschi IA, Zhao G, Luo G, Abdel-Razeq S, Cackovic M, et al. Nucleated red blood cells are a direct response to mediators of inflammation in newborns with early-onset neonatal sepsis. Am j Obstetr Gynecol. 2008 Apr 1;198(4):426-e1.

Liu CH, Lehan C, Speer ME, Fernbach DJ, Rudolph AJ. Degenerative changes in neutrophils: an indicator of bacterial infection. Pediatr. 1984 Nov 1;74(5):823-7.

Sharma A, Kutty CK, Sabharwal U, Rathee S, Mohan H. Evaluation of sepsis screen for diagnosis of neonatal septicemia. Ind J Pediatr. 1993 Jul 1;60(4):559-63.

Pramana KP, Kardana IM, Nilawati GA. Diagnosis accuracy of hematological scoring system in early identification of neonatal sepsis. Age (days old). 2016 Jan 1;3(3):5.

Sriram R, Res IJ. Correlation of blood culture results with the sepsis score and the sepsis screen in the diagnosis of neonatal septicemia. Int J Biol Med Res. 2011 Jan 31;2(1):360-8.

Basu S, Guruprasad NA, Garewal G. Diagnosis of sepsis in the high risk neonate using a hematologic scoring system. Indian J Hematol Blood Transf. 1999;17:32-4.

Khair KB, Rahman MA, Sultana T, Roy CK, Rahman MQ, Shahidullah M, et al. Role of hematologic scoring system in early diagnosis of neonatal septicemia. Bangabandhu Sheikh Mujib Med University J. 2010;3(2):62-7.

Mondal SK, Nag DR, Banyopadhyay R, Chakraborty D, Sinha SK. Neonatal sepsis-Role of certain immunohematologic tests in rapid diagnosis. J Acad Med Sci. 2012 Jul 1;2(3):97.

Meirina F, Lubis B, Sembiring T, Rosdiana N, Siregar O. Hematological scoring system as an early diagnostic tool for neonatal sepsis. Paediatr Indonesiana. 2015;55(6):315-21.