Early diagnosis of neonatal septicemia by hematologic scoring system, C-reactive protein and serum haptoglobin

Neonatal septicemia is one of the major health problems throughout the world. Infections are frequent and important cause of morbidity and mortality in neonatal period. The objective of the present study was to find out the role of hematologic scoring system (HSS), C-reactive protein (CRP) and haptoglobin in the early diagnosis of neonatal septicemia. This is a descriptive consisted of 100 neonates admitted at neonatal ICU, BSMMU, who were clinically suspected sepsis. The hematological parameter, C-reactive protein and haptoglobin were measured in all cases. Blood culture was done as the gold standard for diagnosis of neonatal septicemia. There were 12 out of 100 neonates (12%) who had culture proven sepsis and they were predominantly preterm and very low birth weight. On evaluation of various hematological parameters total leukocyte count, total neutrophil count, immature to total neutrophil ratio (>0.2), immature to mature neutrophil ratio (>0.3), total immature count, platelet count were found to have optimal sensitivities and negative predictive values. Using these values hematologic scoring system (HSS) was formulated according to Rodwell et al. Score ≥4 was found sensitivity of 100%, specificity of 60%. C-reactive protein (CRP) had sensitivity of 75%, specificity of 74%. Haptoglobin was not found significant (p<0.05) with sepsis and sensitivity was very low. But Combination of score ≥4 and CRP showed sensitivity of 75%, specificity 85%, positive predictive value (PPV) 41% and negative positive value (NPV) 96%. HSS and CRP are useful test to differentiate the septicemic from non septicemic neonates and also provide a effective guideline to make decisions regarding judicious use of antibiotic therapy. But haptoglobin level was not found useful for screening of sepsis.