Fatal early onset group B streptococcal sepsis with normal leukocyte counts

In contrast to the attitude prevalent a decade ago, clinicians entertaining the diagnosis of neonatal bacterial sepsis now often place considerable reliance on the blood neutrophil count and degree of left shift. In this report we present four cases which illustrate that in some patients, no derangement of the complete blood count (CBC) is present early in the course of bacterial sepsis. In order to determine the length of time between bacterial inoculation and the appearance of changes in the CBC, we used an animal model of early onset Group B streptococcal sepsis. In adult animals we observed characteristic changes in the CBC within 1 hour of bacterial inoculation, but in neonates this latent period was considerably longer, lasting 4 hours. Thus a normal CBC might actually be expected during the first several hours of early onset neonatal sepsis. This delay in appearance of CBC changes constitutes a previously uninvestigated feature of neonatal neutrophil kinetics, the "latent period."