Role of the Hematological Profile in Early Diagnosis of Neonatal Sepsis

Objective: To evaluate the utility of the hematological parameters for early detection of neonatal sepsis. Study Design: A cross-sectional analytical study. Place and duration of study: The Neonatal Intensive Care Unit of Pakistan Institute of Medical Sciences, Islamabad, over a period of ten months from January to October 2009. Subjects and Methods: All those neonates were enrolled in the study that were suspected to have sepsis or had maternal history of infection. Babies who had a major congenital anomaly, inborn errors of metabolism or a hemolytic jaundice were excluded from the study. Each baby was examined and findings recorded. A septic work up was carried out in all these infants which included complete blood counts, C-reactive protein (CRP) and blood culture with antibiotic sensitivity. The analysis of the peripheral smear was done by the pathologist blinded to the diagnosis of the baby. The parameters studied were the abnormal number of total leucocytes and absolute neutrophil counts, thrombocytopenia and the C-reactive proteins. Results: A total of 138 babies were evaluated for sepsis out which 48 were proved septic by the positive blood cultures. Acinetobacter [35%,n=17] and Klebsiella pneumoniae [25 %, n=12] were the commonest organisms isolated . Analysis of the hematologic profiles revealed that the sensitivities of the parameters studied were below 60 %.However the specificities were more than 70 %. Though, the individual parameters had not the desired specificities but if put together can be a good tool in ruling out the possibility of the neonatal sepsis. The CRP was positive in 11/48 (23%) of proven septic babies and in 14/90 (16%) of babies with probable sepsis. Thrombocytopenia had a sensitivity of 61% and a specificity of 82 %. Conclusion: The hematologic profile that we studied can be a good test in detection of culture negative cases of neonatal sepsis. Though, not a very sensitive tool but it is a simple, quick, cost effective and readily available. It cannot provide a guideline to decisions regarding antibiotic therapy.