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Evaluation of Hematological Scoring System in the Diagnosis of Neonatal Sepsis

Chandrakala R. Iyer Associate Professor, Department of Paediatrics, P.E.S. Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh 517425, India. E-mail: , B.N. Kumarguru1 , Chandrakala R. Iyer2 , A.S. Ramaswamy3 , G. Naveen4 , H.R. Suma5 , Amita Ray6

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Indian Journal of Pathology: Research and Practice 7(6):p 746-753, June 2018. | DOI: DOI: http://dx.doi.org/10.21088/ijprp.2278.148X.7618.6

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Abstract

Introduction: Neonatal septicemia constitutes one of the major public health problems throughout the world. Early diagnosis of neonatal sepsis poses a great challenge. Hematological scoring system [HSS] formulated by Rodwell et al. can be used to establish early diagnosis of sepsis in neonates. 

Objectives: To evaluate the utility of conventional HSS and modified HSS as a diagnostic tool in the setting of neonatal sepsis and to evaluate the role of additional parameters like nucleated RBC count, Neutrophil Lymphocyte Ratio [NLR] and Platelet Lymphocyte Ratio [PLR] in the diagnosis of neonatal sepsis. '

Materials and Methods: The study was conducted in hematology section of the department of pathology at a rural tertiary care referral institute. It was a prospective study done over a period of six months from January 2015 to June 2015. Fifty-one cases were analyzed. All high risk neonates admitted to NICU [Neonatal Intensive Care Unit] were included in the study. Clinically, neonates were grouped into three categories. Conventional hematological scoring system [HSS] and Modified hematological scoring system were applied to all the cases. Additional hematological parameters like nucleated RBC count, NLR and PLR were also evaluated.

Results: Both conventional hematological scoring system and modified hematological scoring system were found to be statistically significant by Chi-square test (P < 0.05) for clinical correlation. NLR ratio was statistically significant (P < 0.05) for clinical correlation. Nucleated RBC count and PLR were found to be statistically not significant (P > 0.05) for clinical correlation. Sensitivity of conventional HSS and modified HSS were similar (100%) with respect to total WBC count, immature polymorphonuclear neutrophils (PMN) count, immature: total PMN ratio, immature: mature PMN ratio and degenerative changes in PMN. Specificity of total WBC count was better in conventional HSS. Specificity of platelet count was better in modified HSS. 

Conclusion: Hemalotogical scoring system is a useful, simple and reliable tool for evaluating neonatal sepsis. But, modified HSS appears to be more meaningful scoring system than conventional HSS.

Keywords: Diagnostic; Parameter; Neutrophils.

 

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DOI: DOI: http://dx.doi.org/10.21088/ijprp.2278.148X.7618.6

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