Early Diagnosis of Neonatal Sepsis Using Hematological Profiles

ABSTRACT

Preterm and extremely low-birth-weight newborns are at a higher risk for early-onset neonatal sepsis (NN-SP). This condition is often linked to intrapartum fever, PROM, and sepsis occurring within the first day of life. The causal pathogen can be acquired through intrauterine transmission or from the mother’s flora. Therefore, our study aimed to evaluate PC and PI in cases involving NN-SP. Therefore, we can conclude that analyzing the PC and its indices can improve the prognosis of sepsis in NN. Studying NN using this method is a cost-effective approach that helps prevent mortality and morbidity. Early identification of newborn sepsis can help reduce the associated medical tests and medical bills. Clinical correlation with specific indicators and tools is a method for achieving this.

INTRODUCTION

A worldwide health concern, neonatal (NN) septicemia is a leading cause of infant mortality (I-MT) and morbidity (MB) throughout the perinatal (PN) and NN periods.[1] Among newborns, sepsis is the leading cause of MT.[1] The possibility of acquiring neurological deficits exists. Many different types of bacteria may cause NN sepsis (SP). The most frequent ones are Klebseilla pneumonia, Escherichia coli, Listeria, and some strains of Group B streptococcus. The management of NN age includes a number of recent developments, including the use of stronger antibiotics.[2] Advanced biomarkers (BMs) aid in the early diagnosis of NN-SP, leading to improved NN care and a decrease in NN-MT and MB.[3,4] Improved patient prognosis is possible because of the correlation of these BM with certain clinical characteristics, symptoms, and signs. A positive blood culture, which takes at least 48 to 72 hours to produce, is the only reliable way to diagnose septicemia.[5] For blood culture to be performed, it is essential to have labs that are well equipped. For the early diagnosis of NN-SP, a complete blood count (BC) and platelet parameters (PPs) are tests that are readily accessible.[6] Results on peripheral smear (PS) PC and its parameters indicate SP, together with hematological indices (HT-I).[7] Obtaining the results within an hour and administering antibiotics promptly can significantly enhance the prognosis for survival in cases of septicemia.[7] Early, accurate, and prompt diagnosis of NN-SP is a significant diagnostic challenge in neonatology. In order to determine their role as a prognostic and early indicator of NN-SP, the current study was undertaken to assess PC and early index.

AIM

To evaluate PC and PI in cases of NN-SP.

Inclusion criteria

NN presenting with NN-SP.

Exclusion criteria

1. NN with bleeding disorder (BD) in family.

2. NN with exchange transfusion and maternal immune thrombocytopenic purpura (MI-TCPPP).

MATERIALS AND METHOD

The study was conducted in the hematology division of the pathology department at a tertiary care hospital. The study was conducted over a 2-year period, from July 2020 to August 2022. We will be conducting a study on newborns who display clinical symptoms of SP and are admitted to the Neonatal Intensive Care Unit (NICU) during the same period.

Equipment

1. Part Automated Hematology analyzer (NIHON KOHDEN MEK-9100)

2. EDTA vaccutainer

3. Leishman’s stain

4. Slides: Clean, grease free slide.

Laboratory quality control

In addition to adhering to the standard standards established by the National Accreditation Board for Laboratories (NABL), the laboratory also participates in External Quality Assurance Services (EQAS) and has an internal quality control program.

The HT-P were compared to the NN clinical characteristics as well as existing BC reports and CRP levels. All 117 newborns were analyzed using the HT-P listed above, as well as their clinical characteristics.

Parameter analyzed

Clinical characteristics of the newborn infant, CRP, Hb, total leucocyte count (TLC), differential count (DC), PC, PI (MPV and PDW), BC, and PC are among tests that are performed.

Analysis of data

The collected data were statistically analyzed using SPSS software to establish the relationship between platelet count, its indices, and clinically confirmed cases of SP in infants.

Facilities

The pathology department and our institution provided all necessary facilities for the study.

Risk factor

No risk factor,

RESULT

In Table 1, we have found that over half of the patients (78/66.66%) had low platelet counts, while the other 39 (33.34%) had normal platelet levels.

Table 1.

Distribution of PC

Platelet count (cells/mm3) (1,50,000-4,50,000) cells/mm3	No of cases	Percentage (%)
<1,50,000	78	66.66
1,50,000-4,50,000	39	33.34
Total	117	100

In Table 2, we have found that the majority of cases, namely, 86 cases (73.50%), had an elevated PDW.

Table 2.

Distribution of PDW

Platelet Distribution width (10-17%)	No of cases	Percentage (%)
>19.1	86	73.50
<19.1	31	26.50
Total	117	100

Abnormal peripheral smear findings in clinically positive blood culture immature polymorphonuclear leucocytes (Band Form)

Band formations in clinically suspected blood culture-positive newborns were categorized, along with the reference range and increased cell count. There were 25 cases of newborn SP with positive blood cultures. In 21 of them, 84%, immature polymorphonuclear leukocytes (band form) were found [Tables 3 and 4].

Table 3.

Comparative studies of PD

	Choudhary et al. (2018)	Majumdar et al. (2021)[8]	Present study
>19.1	65.81%	72%	73.5%
<19.1	34.19%	28%	26.5%

Table 4.

Comparative studies of PV

	Choudhary et al. (2018)	Majumdar et al. (2021)[8]	Present study
>10.8	70.91%	86%	86%
<10.8	29.08%	14%	14%

DISCUSSION

Based on the findings of the study, Klebsiella pneumonia was the most frequently detected organism in the blood culture, with E. coli being the second most common. The findings of our investigation align with the research conducted by Majumdar et al.,[8] and it was the most frequently detected organism. The most common clinical symptom found in neonates with SP in this study was respiratory distress. Majumdar et al. (2022)[8] reported a similar finding.

The current research found that 91.45% of cases had hemoglobin levels ranging from 13.1 to 20 g/dl, which is consistent with the findings of Adane et al. (2022), who reported a prevalence of 61.5% within the same range.[9,10,11,12]

CONCLUSION

Outpatient delivery was most common in 75 cases (64.10%) of the 117 neonates with clinically confirmed cases of sepsis, with cesarean sections being more common than vaginal births (70.08% vs. 29.9%). The most frequent maternal complication was premature membrane rupture (41.8%). Out of the 117 neonates, 21.36% had positive blood cultures, with Klebsiella pneumonia being the most prevalent organism. Early onset sepsis was the most common presentation (52.99%), with elevated CRP levels observed in 90% of cases and respiratory distress in 90.59%. Leucopenia was present in 42.73% of cases. Analyzing platelet count and its indices could improve sepsis prognosis, making it a cost-effective method to prevent morbidity and mortality in neonates through early detection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.