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.