effect of different infectious organisms on platelet count and platelet indices in VLBW infants with septicemia

Preterm and VLBW infants are at increased susceptibility to sepsis with subtle nonspecific initial presentations therefore, they require much vigilance so that sepsis can be identified and treated effectively. Thrombocytopenia with counts less than 100,000 may occur in neonatal sepsis. MPV and PDW have been shown to be significantly elevated in infants with sepsis after 2-3 days of life. Our objectives were to study the effect of different organisms causing neonatal sepsis in VLBW infants on platelet count and platelet indices. Fifty VLBW infants with culture proven neonatal sepsis admitted to the NICU of the neonatal department at Al Galaa Teaching Maternity Hospital were studied prospectively over a six months period. All babies who were suspected of having sepsis had a full sepsis screen and were culture proven, following a full clinical evaluation. Platelet count and platelet indices including PDW and MPV were calculated. The results were statistically analyzed using student t-test. The mortality rate in culture proven sepsis infants in this study was 10%. Thrombocytopenia, defined as platelet count <100.000/mm[3], was observed in 35/50 [70%] of cases. The initial platelet count at the onset of sepsis was statistically significantly higher with gram-positive organisms [190.520 +/- 7.310/mm[3]] than with Gram-negative [121.670 +/- 4.850/mm[3]] and fungal organisms [112.480 +/- 4.100/mm[3]]. The MPV and PDW in newborns with sepsis showed statistically significant increase from base line, and were statistically significantly higher in fungal and Gm - ve sepsis than in Gm + ve sepsis group [p<0.05]. Common organisms causing neonatal sepsis in VLBW infants exert different effects on platelet count and platelet indices

C-Reactive Protein: a tool for guiding duration of antimicrobial therapy in high-risk neonates

Serial measurements of C-reactive protein [CRP] values along with other indices for screening neonatal sepsis, including total white cell count [TWCC], absolute neutrophil count [ANC], immature to total neutrophil ratio [I:T ratio] and blood culture, was studied in 346 neonates, with risk factors, admitted to SCBU, at the Neonatal Department of El-Galaa Teaching Hospital. All infants with suspected bacterial infection, either EOS [<72 hours of age] or LOS [>72 hours of age] were started on antibiotic treatment according to the department guidelines. The data for indices of infection were collected and analyzed for sensitivity, specificity, PPV and NPV. A cut-off value for a significant CRP was >12 mg% to suspect neonatal infection in the presence of suggestive clinical manifestations. It was found that serial CRP measurements had a sensitivity of 91% and a specificity of 95%. The PPV for serial CRP values was 90.03% [95% CI 85-92%] and the NPV was 61% [95% CI 48-73%]. The combination of CRP and I:T ratio raised the sensitivity to 93%, while combining CRP, ANC and I:E ratio raised the sensitivity further to 97%. These results make the use of serial measurements of CRP values for the diagnosis of EOS and LOS and to guide antibiotic therapy in these infants a safe and practical approach