Early diagnosis and evaluation of neonatal septicemia by hematological scoring system

ABSTRACT

Background: Neonatal septicemia is a major health problem. Morbidity and mortality in the neonatal period are mostly due to neonatal septicemia. Objective: The present study was undertaken to highlight the importance of hematological scoring system (HSS) in the early diagnosis and evaluation of neonatal septicemia and to correlate these hematological parameters with blood culture and C-reactive protein. Materials and Methods: This study was prospective and was done over the period of 1 year including 100 clinically suspected neonatal septicemia cases admitted in neonatal intensive care unit. Hematological parameters were measured in all cases. Culture positivity was taken as the criterion for definitive diagnosis. Specificity, sensitivity, positive predictive value, negative predictive value, and P value were calculated for each hematological parameter. Results: Of 100 clinically suspected neonates with sepsis studied, 19% were culture positive, 63.2% were male, 84.2% were term neonates, and 84.2% were low birth weight neonates (<2.5 kg). Early onset septicemia was more common (73.6%). In neonates who were delivered by spontaneous vaginal delivery (73.7%), septicemia was more common and also in neonates who were delivered in the hospital (84.2%). Klebsiella pneumoniae was the most common organism isolated (36.8%). By comparison of Rodwell’s HSS with blood culture results, it was found that the presence of likelihood of sepsis with score ≥3 was 59.25 % and with score ≥5 was 100%. With score ≤2, the likelihood of sepsis was absent (95.9%). Conclusion: HSS is useful for distinguishing the infected infants from non-infected infants. It is also useful to provide an effective guideline for making decisions regarding the proper use of antibiotics for early treatment.