Dr. Rajesh Singh Laishram

BACKGROUND Sepsis is the commonest cause of neonatal mortality. Early recognition of neonatal sepsis is difficult as the clinical signs and symptoms are non-specific and the failure or delay in treatment may result in significant mortality and morbidity. MATERIALS AND METHODS Blood samples were taken from neonates attending Regional Institute of Medical Sciences, Imphal, Manipur, India with clinical features of sepsis. Various haematological tests were performed including haemoglobin level, total WBC count, total PMN count, immature PMN count, I:T PMN ratio, I:M PMN ratio, degenerative changes in PMN and platelet count. Haematological scoring and blood culture were done for each case. Correlation of the various haematological parameters was done with the blood culture. RESULTS A total of 101 neonates with clinical features of neonatal sepsis were included in the study. Out of all the cases, 59 (58.4%) cases were ≤7 days of age. Early onset sepsis was present in 58.4% of cases and late onset sepsis was present in 41.6% of the cases. Bacterial culture was positive in 27 (26.7%) cases. Among the organisms grown, coagulase negative staphylococci (CoNS) was the most common organism accounting to about 55.6%. Abnormal total PMN count had the highest sensitivity of 96.2% but the lowest specificity of 28.4%, among all the individual parameters. 47 cases had a haematological score ≤2, 38 cases had a score of 3-4 and 16 cases had a score ≥5. The sensitivity, specificity, positive predictive value and negative predictive values of the tests increased as the score increased. Also, the specificity of the two-test combination was either similar to or higher than the individual test at the cost of sensitivity. CONCLUSION None of the haematological parameters studied can be used alone for a reliable diagnosis of neonatal sepsis. However, a combination of tests and a haematological scoring system is a very useful diagnostic aid to the clinicians.