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.
ABSTRACT
Background: Neonatal hyperbilirubinemia, though benign in 80% cases, can lead to kernicterus if not diagnosed and treated early. The golden method of estimation is measuring serum bilirubin levels. Both Kramer's scale and Transcutaneous bilirubinometer are non -invasive methods. Its high time the pediatricians choose an ideal non-invasive and reliable method to detect hyperbilirubinemia. Objective of this study is to find out which has a better correlation with serum bilirubin - transcutaneous bilirubinometer reading (TcB) or Kramer's scale.Methods: The study was conducted in a tertiary newborn center from November 2014 to June 2016. The inclusion criteria included all babies above 34 weeks gestation and exclusion criteria included babies with established direct hyperbilirubinemia, neonatal septicemia, major congenital/ gastrointestinal malformations and those on phototherapy. The sample size was 450 and the correlation was analyzed using ROC curves and plots of agreement was done using Bland Altman charts.Results: The incidence of significant Hyperbilirubinemia is 12%. Transcutaneous bilirubin level had a better correlation and prediction level compared to Kramer at both 24 hours and 48 hours. Bland Altman analysis showed that transcutaneous values were closer to the total serum bilirubin level compared to Kramer values.Conclusion: Transcutaneous bilirubinometry is a better and more ideal choice to replace serum bilirubin levels. In settings where TcB is not feasible, it's always best to screen for jaundice using Kramer's scale rather than estimating serum bilirubin values in all babies. In babies where TcB levels are above the cut off range, it's better to do serum bilirubin levels.