Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 409
About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Advertise Login 
Year : 2013  |  Volume : 2  |  Issue : 1  |  Page : 25-29

Performance evaluation of hematologic scoring system in early diagnosis of neonatal sepsis

1 Department of Pathology, M. M Institute of Medical Sciences and Research, Mullana, Ambala (Haryana), India
2 M. M Institute of Medical Sciences and Research, Mullana, Ambala (Haryana), India
3 Department of Community Medicine, M. M Institute of Medical Sciences and Research, Mullana, Ambala (Haryana), India

Correspondence Address:
Manisha Makkar
Sector 4, House No. 231, Panchkula - 134 112, Haryana
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2249-4847.109243

Rights and Permissions

Objectives: The present study was undertaken to evaluate and highlight the importance of hematological scoring system (HSS) in the early detection of neonatal sepsis. Materials and Methods: The cross-sectional study enrolled 110 neonates who were clinically suspected of infection (study group) and normal neonates for comparison (controls), during the 1 st week of life. All peripheral blood smears were analyzed using HSS of Rodwell et al., by pathologists blinded to the infection status of the newborns. HSS assigns a score of 1 for each of seven findings significantly associated with sepsis: Abnormal total leukocyte count, abnormal total polymorphonuclear neutrophils (PMN) count, elevated immature PMN count, elevated immature: Total (I:T) PMN ratio, immature: Mature (I:M) PMN ratio ≥0.3, platelet count ≤150,000/mm 3 , and pronounced degenerative or toxic changes in PMNs. Score of ≤2 was interpreted as sepsis unlikely; score 3-4: Sepsis is possible and ≥5 sepsis or infection is very likely. Blood culture was taken as a standard indicator for septicemia. The perinatal history, clinical profile and laboratory data were recorded and correlated in each case. Each hematological parameter was assessed for its individual performance and also with the culture-proven sepsis. Sensitivity, specificity, positive and negative predictive values (NPVs) were calculated for each parameter and for different gestational ages. P value was also calculated for different parameters. Results: Out of the 110 infants, based on clinical findings and laboratory data were classified into three categories: Sepsis ( n=42), probable infection ( n=22) and normal ( n=46). Out of these, 42 (38.2%) newborns had positive blood culture. 63 (57%) neonates were preterm and 47 (43%) term. Male: female ratio was 0.96:1. The P value was significant for the different gestational ages (0.0002) and sex ratio (0.003). Immature polymorphonuclear neutrophils (PMN) count was the most sensitive and I:M PMN ratio, the most specific indicator of sepsis. For sepsis and probable sepsis, I:T PMN count and immature PMN count have highest sensitivity whereas I:T and I:M PMN ratio have highest specificity. HSS has much higher sensitivity and specificity in preterms than in term neonates. Positive predictive value and NPV is also higher in preterm than term for HSS. It was also seen that with increasing scores, the likelihood of sepsis also increased. Conclusion: The sensitivities of the various screening parameters were found to be satisfactory in identifying early onset neonatal sepsis. It is a simple and feasible diagnostic tool to guide towards the decision-making for a rationale treatment.

Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
  Search Pubmed for
  Search in Google Scholar for
Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded1554    
    Comments [Add]    
    Cited by others 18    

Recommend this journal