Hematological scoring system as an early diagnostic tool for neonatal sepsis

  • Fathia Meirina Department of Child Health, University of Sumatera Utara Medical School /H. Adam Malik Hospital, Medan, North Sumatera, Indonesia.
  • Bidasari Lubis Department of Child Health, University of Sumatera Utara Medical School /H. Adam Malik Hospital, Medan, North Sumatera, Indonesia.
  • Tiangsa Sembiring Department of Child Health, University of Sumatera Utara Medical School /H. Adam Malik Hospital, Medan, North Sumatera, Indonesia.
  • Nelly Rosdiana Department of Child Health, University of Sumatera Utara Medical School /H. Adam Malik Hospital, Medan, North Sumatera, Indonesia.
  • Olga Siregar Department of Child Health, University of Sumatera Utara Medical School /H. Adam Malik Hospital, Medan, North Sumatera, Indonesia.
DOI: https://doi.org/10.14238/pi55.6.2015.315-21
Keywords: hematological scoring system; sepsis; neonatal sepsis

Abstract

Background Sepsis was the leading cause of death in babies by 30%-50% in developing countries. Early diagnosis of neonatal sepsis is still a difficult problem because of clinical features are not specific. Blood culture is the gold standard, but it takes several days and is expensive. The hematological scoring system (HSS) consists of hematologic parameters (leucocyte count, polymorphonuclear (PMN) cells, degenerative changes, and platelet count) for early diagnosis of neonatal sepsis. Objective To measure HSS as an early diagnostic tool for neonatal sepsis. Methods A cross sectional study was conducted in March to June 2013. Samples were collected by consecutive sampling. Fourty neonates suspected sepsis in neonatology unit H. Adam Malik Hospital, Medan, North Sumatera, underwent routine blood count, blood culture, and peripheral blood smear. Each hematologic parameters were analysed using the HSS of Rodwell et al. The hematologic parameters were total leucocyte count, total PMN cells, total PMN immature, I:T PMN ratio, I:M PMN ratio, degenerative changes, and platelet count. The total value revealed HSS score. Diagnostic study parameters were calculated. Results Ten of fourty neonates had sepsis based on blood culture results. The HSS score >=4 had sensitivity 80%, specificity 90%, with positive predictive value (PPV) 73%, negative predictive value (NPV) 93%, ROC curve showed cut off point 0.902 (95% CI 0.803 to 1.0). Conclusion Score HSS >=4 could be used as an early diagnostic tool for neonatal sepsis.

References

Gardner SL. Sepsis in the neonate. Crit Care Nurs Clin N Am. 2009;21:121-41. doi: 10.1016/j.ccell.2008.11.002.

Garcia-Parts JA, Cooper TR, Schneider VF, Stager CE, Hansen TN. Rapid detection of microorganisms in blood cultures of newborn infants utilizing an automated blood culture system. Pediatrics. 2000;3:523-7.

Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr. 1988;112:761-7.

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.

Narasimha A, Kumar MLH. Significance of hematological scoring system (HSS) in early diagnosis of neonatal sepsis. Indian J Hematol Blood Transfus. 2011;27:14-7.

Mulyani A, Setyowireni D, Surjono A. The diagnostic accuracy of clinical and blood examination. Berkala Ilmu Kedokteran. 2002;34:149-54.

Xanthou M. Leucocyte blood picture in health full-term and premature babies during neonatal period. Arch Disease Child. 1970;45:242-9.

Amirullah A. Sepsis pada bayi baru lahir. In: Kasim SM, Yunanto A, Dewi R, Sarosa IG, Usman A, editors. Buku ajar neonatologi. Jakarta: Ikatan Dokter Anak Indonesia; 2008. p. 170-87.

Buch AC, Srivastava C, Khumar H, Jadav PS. Evaluation of hematological profile in early diagnosis of clinically suspected. IJBAMS. 2011;1:1-6.

Mayuga WA, Isleta PF. Clinical correlation of neonatal and Fathia Meirina et al: Hematological scoring system as an early diagnostic tool for sepsis maternal hematological parameters as predictors of neonatal sepsis. PIDSP Journal. 2005;9:36-43.

Bhat R, Rao A. The performance of haematological screening parameters and CRP in early onset neonatal infection. J. Clin Diag Research. 2010;4:3331-6.

Palazzi DL, Klein JO, Baker CJ. Bacterial sepsis and meningitis. In: Remington JS, Klein JO. editors. Infectious disease of the fetus and newborn infant. 6th edition. Philadelphia: Elsevier Saunders; 2006. p.247-86.

Ravishankar K. Laboratory diagnosis of neonatal sepsis. J Neonatol. 2009;23:48-52.

Vazzalwar R, Pina-Rodrigues E, Puppala BL, Angst DB, Schweig L. Procalcitonin as ascreening test for late onset sepsis in preterm very low birth weight infats. J Perinatol. 2005;25:397-402.

Sianturi P, Hasibuan BS, Lubis BM, Azlin E, Tjipta GD. Profil sepsis neonatus di unit perawatan neonatus RSUP.H Adam Malik Medan tahun 2008-2010. Sari Pediatri. 2012; 14:67- 72.

Enrione MA, Powell KR. Sepsis, septic shock, systemic inflammatory respon. In: Behrman RE, Kiegman RM, Jenson HB, Stanton BF, editors. Nelson textbook of pediatrics. 18th edition. Philadelphia: Saunders Company; 2007.p.1094-9.

Kuppermann N, Walton EA. Immature neutrophils in the blood smears of young febrile children. Arch Pediatr Adolesc Med. 1999;153:261-6.

Aulia E, Sanjaya AI, Timan IS. The use of immature to total neutrophil (IT) ratio to detect bacteriemia in neonatal sepsis. J. Lab. Med. & Quality Assuarance. 2003;25:237-42.

Stoll BJ. Infections of the neonatal infant. In: Behrman RE, Kiegman RM, Jenson HB, Stanton BF, editors. Nelson textbook of pediatrics. 18th edition. Philadelphia: Saunders Company; 2007.p.794-811.

Gomella TL, Cuningham MD, Eyal FG, Zenk KE. Sepsis. In: Gomella TL, Cuningham MD, Eyal FG, Zenk KE, editors. Management, procedures, on-call problems, disease and drugs. New York: Mc Graw-Hill; 2009.p.665-72.

Franz AR, Kron M, Pohland F, Steinbach G. Comparison of procalsitonin with interleukin 8, C-reactive protein and differential white blood cell count for the early diagnosis of bacterial infections in new born infants. J Pediatr. 1999:18-66.

Thomas BN, Karen MP, Soora W, David D, Gabriel JE. Interpreting complete blood counts soon after birth in newborn at risk for sepsis. Pediatrics. 2010; 126:903-9. 23. Tripathi S. Neonatal Sepsis: past, present and future; a review article. Internet J Med Update. 2010;5:45-54.

Hornik CP, Benjamin DK, Becker KC, Benjamin Jr DK, Li J, Clark RH, et al. Use of the complete blood cell count in early-onset neonatal sepsis. Pediatr Infect Dis J. 2012;31:799- 802.

Bender L, Thaarup J, Varming K, Krarup H, Eriksen SE, Ebbesen F. Early and late markers for detection of early onset neonatal sepsis. Dan Med Bull. 2008;55:219-23.

Published
2016-11-30
How to Cite
1.
Meirina F, Lubis B, Sembiring T, Rosdiana N, Siregar O. Hematological scoring system as an early diagnostic tool for neonatal sepsis. PI [Internet]. 30Nov.2016 [cited 15Nov.2024];55(6):315-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/64
Issue
Vol 55 No 6 (2015): November 2015
Section
Articles

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.

Received 2016-02-12
Accepted 2016-02-12
Published 2016-11-30