A comparison of neutrophil gelatinase-associated lipocalin and immature to total neutrophil ratio for diagnosing early-onset neonatal sepsis

  • Rocky Wilar Department of Child Health, Sam Ratulangi University Medical School/Prof. Dr. R. D. Kandou Hospital, Manado.
  • Dasril Daud Department of Child Health, Hasanuddin University Medical School/Dr. Wahidin Sudirohusodo Hospital, Makasar.
  • Suryani As’ad Department of Child Health, Hasanuddin University Medical School/Dr. Wahidin Sudirohusodo Hospital, Makasar.
  • Dwi Bahagia Febriani Department of Child Health, Hasanuddin University Medical School/Dr. Wahidin Sudirohusodo Hospital, Makasar.
  • Mina Mina Department of Child Health, Sam Ratulangi University Medical School/Prof. Dr. R. D. Kandou Hospital, Manado.
DOI: https://doi.org/10.14238/pi56.2.2016.107-10
Keywords: EONS, NGAL, IT ratio, newborn

Abstract

Background Neonatal sepsis is a clinical syndrome caused by the invasion of microorganisms into the bloodstream. Early diagnosis of early-onset neonatal sepsis (EONS) is difficult. Laboratory tests with high sensitivity and specificity are needed in order to make early diagnoses in newborns.
Objective To compare the sensitivity and specificity of neutrophil gelatinase-associated lipocalin (NGAL) and immature to total (IT) neutrophil ratio for the diagnosis of early-onset neonatal sepsis.
Methods This observational study with cross-sectional design was conducted in the Neonatology Division, Prof. R. D. Kandou General Hospital from November 2012 to April 2014. Consecutive sampling was applied. There were 103 newborns with suspected EONS who fulfilled the inclusion criteria. Complete blood counts, blood cultures, as well as NGAL and IT ratio measurements were performed.
Results NGAL was not significantly more sensitive than IT ratio [80.4% vs. 67.3%, respectively; (P=0.058)]. However, NGAL had lower specificity than IT ratio (27.7% vs. 50.0%, respectively; P=0.016). The positive predictive values (57.0% vs. 64.9%, respectively; P=0.176), and negative predictive values (54.2% vs. 52.6%, respectively; P=0.451) were similar in both diagnostic tests.
Conclusion Immature to total neutrophil (IT) ratio has higher specificity compared to NGAL for early diagnosis of EONS. However, the difference in sensitivity between the two test is not statistically significant.

Author Biography

Rocky Wilar, Department of Child Health, Sam Ratulangi University Medical School/Prof. Dr. R. D. Kandou Hospital, Manado.

 

 

References

1. Musdalifah E, Juffrie M, Purnomo S, Amalia. Association between neutropenia and death rate of bacterial neonatal sepsis. Paediatr Indones. 2008;48:284-7.
2. Kardana IM. Incidence and factors associated with mortality of neonatal sepsis. Paediatr Indones. 2011;51:144-8.
3. Aminullah A. Masalah terkini sepsis neonatorum. In: Hegar B, Trihono PP, Irfan EB, editors. Update in neonatal infection. Jakarta: Balai Penerbit FKUI; 2005. p. 1-15.
4. Cimenti C, Erwa W, Muller W, Resch B. The role of immature granulocyte count and immature myeloid information in the diagnosis of neonatal sepsis. 2013; [cited 2013 July 1]. Available from: http://www.intechopen.com.
5. Satar M, Ozlu F. Neonatal spsis: a continuing disease burden. Turk J Pediatr. 2012;54:449-57.
6. Kjedlsen L, Bainton DF, Sengelov H, Borregaard N. Identification of neutrophil gelatinase-associated lipocalin as a novel matrix protein of specific granules in human neutrophils. Blood. 1994;83:799-807.
7. Xu SY, Petersson CGB, Carlson M, Venge P. The development of an assay for human neutrophil lipocalin (HNL)--to be used as a specific marker of neutrophil activity in vivo and vitro. J Immunol Methods. 1994;171:245-52.
8. Axelsson L, Bergenfeldt M, Ohlsson K. Studies of the release and turnover of a human neutrophil lipocalin. Scand J Clin Lab Invest. 1995;55:577-88.
9. Wilar R, Kumalasari E, Suryanto DY, Gunawan S. Faktor risiko sepsis awitan dini. Sari Pediatri. 2010;12:265-9.
10. Thermiany AS, Retayasa W, Kardana M, Lila IN. Diagnostic accuracy of septic markers for neonatal sepsis. Paediatr Indones. 2008;48:299-305.
11. Aminullah A, Gatot D, Kosim MS, Rohsiswatmo R, Indarso F, Dharma R, et al. Penatalaksaan sepsis neonatorum. Jakarta: DEPKES; 2007. p. 1-85.
12. Triphati S, Malik GK. Neonatal sepsis: past, present and future; a review article. Internet J Med Update. 2010;5:45-54.
13. Khinchi YR, Kumar A, Yadav S. Profile of neonatal. J Coll Med Sci-Nepal. 2010;6:1-6.
14. Ferrieri P, Wallen LD. Neonatal bacterial sepsis. In: Gleason CA, Devaskar SU, editors. Avery’s disease of the newborn. 9th ed. Philadelphia: Saunders Elsevier; 2012. p. 538-50.
15. Susanto SA. Hubungan jumlah leukosit dan kadar neutrophil gelatinase associated lipocalin pada sepsis neonatorum [thesis]. [Manado]: Universitas Sam Ratulangi; 2011.
16. Putra PJ. Insiden dan factor-faktor yang berhubungan dengan sepsis neonates di RSUP Sanglah Denpasar. Sari Pediatri. 2012;14:205-10.
17. Lawn JE, Wilczynska-Ketende K, Cousens SN. Estimating the causes of 4 millon neonatal deaths in the year 2000. Int J Epidemiol. 2006;35:706-18.
18. Khair KB, Rahman MA, Sultana T, Roy CK, Rahman MQ, Shahidullah M, et al. Role of hematologic scoring system in early diagnosis of neonatal septicemia. BSMMU J. 2010;3:62-7.
19. Melvan JN, Bagby GJ, Welsh DA, Nelson S, Zhang P. Neonatal sepsis and neutrophil insufficiencies. Int Rev Immunol. 2010;29:315-48.
20. Polin RA, Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics. 2012;129:1006-15.
21. Makkar M, Gupta C, Pathak R, Garg S, Mahajan NC. Performance evaluation of hematologic scoring system in early diagnosis of neonatal sepsis. J Clin Neonatol. 2013;2:25-9.
22. Fjaertoft G, Foucard T, Xu S, Venge P. Human neutrophil lipocalin (HNL) as a diagnostic tool in children with acute infections: a study of the kinetics. Acta Paediatr. 2005;94:661-6.
23. Schmidt-Ott KM, Mori K, Kalandadze A, Li JY, Paragas N, Nicholas T, et al. Neutrophil gelatinase-associated lipocalin-mediated iron traffic in kidney epithelia. Curr Opin Nephrol Hypertens. 2006;15:442-9.
24. Tadesse S, Luo G, Park JS, Kim BJ, Snegovskikh VV, Zheng T, et al. Intra-amniotic infection upregulates neutrophil gelatinase-associated lipocalin (NGAL) expression at the maternal-fetal interface at term: implications for infection-related preterm birth. Reprod Sci. 2011;18:713-22.
Published
2016-07-19
How to Cite
1.
Wilar R, Daud D, As’adS, Febriani DB, Mina M. A comparison of neutrophil gelatinase-associated lipocalin and immature to total neutrophil ratio for diagnosing early-onset neonatal sepsis. PI [Internet]. 19Jul.2016 [cited 20Apr.2024];56(2):107-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/118
Issue
Vol 56 No 2 (2016): March 2016
Section
Neonatology

Authors who publish with this journal agree to the following terms:

Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Received 2016-07-19
Accepted 2016-07-19
Published 2016-07-19