Early diagnosis of neonatal sepsis using a hematological scoring system

To assess the utility of the hematologic scoring system (HSS) of Rodwell et al for the early detection of neonatal sepsis.

Analysis of the peripheral smear findings according to the HSS by a pathologist blinded to the infection status of the neonate.

One hundred and three high risk neonates having predisposing perinatal factors or clinical suspicion of sepsis.

Analysis of the hematologic profiles in the light of the HSS found that an abnormal immature to total neutrophil (1:T) ratio followed by an abnormal immature to mature neutrophil (1:M) ratio were the most sensitive indicators in identifying infants with sepsis. These two criteria along with thrombocytopenia (< 1,50,000/cm3) had a high negative predictive value over 94%. The study also found that the higher the score the greater the certainty of sepsis being present.

The HSS is simple, quick, cost effective and readily available tool in the early-diagnosis of neonatal sepsis and could provide a guideline to decisions regarding antibiotic therapy.