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Updated: May 22, 2026
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Use of the complete blood cell count in late-onset neonatal sepsis
Christoph P Hornik1, Daniel K Benjamin, Kristian C Becker
1Department of Pediatrics, Duke University, Durham, NC 27715, USA.
Background:
Late-onset sepsis is an important cause of morbidity and mortality in infants. Diagnosis of late-onset sepsis can be challenging. The complete blood cell count and differential have been previously evaluated as diagnostic tools for late-onset sepsis in small, single-center reports.
Objective:
We evaluated the diagnostic accuracy of the complete blood cell count and differential in late-onset sepsis in a large multicenter population.
Study Design:
Using a cohort of all infants with cultures and complete blood cell count data from a large administrative database, we calculated odds ratios for infection, as well as sensitivity, specificity, positive and negative predictive values and likelihood ratios for various commonly used cut-off values.
Results:
High and low white blood cell counts, high absolute neutrophil counts, high immature-to-total neutrophil ratios and low platelet counts were associated with late-onset sepsis. Associations were weaker with increasing postnatal age at the time of the culture. Specificity was highest for white blood cell counts <1000/mm and >50,000/mm (>99%). Positive likelihood ratios were highest for white blood cell counts <1000/mm (4.1) and platelet counts <50,000/mm (3.5).
Conclusion:
No complete blood cell count index possessed adequate sensitivity to reliably rule out late-onset sepsis in this population.