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. 2022 Jul 10;11(7):928. doi: 10.3390/antibiotics11070928

Table 2.

Predictive scores for the LOS with laboratory variables.

Reference Country, Year Method Design Population Scoring System (Points) Main Findings
[23] Australia, 1988 Prospective Original (HSS) 287 neonates: 298 episodes (27 sepsis, 23 probable infection, 248 non infected)
Group 1: 243 neonates (≤24 h of age)
Subgroup 1: 113 neonates (preterm)
Subgroup 2: 130 neonates (term)
Group 2: 55 neonates (days 2–30)
Age 1–30 days (EOS and LOS), with perinatal risk factors or clinical suspicion of sepsis

  • Immature to total neutrophil(I:T) ratio (↑) (1)

  • Total PMN count (↑/↓) (1 or 2)

  • Immature to mature (I:M) neutrophil ratio (≥0.3) (1)

  • Immature PMN count (↑) (1)

  • Total WBC count (↑/↓: ≤5.000/mm3 or ≥25.000, 30.000 and 21.000 at birth, 12–24 h and day 2 onward, respectively) (1)

  • Degenerative changes in PMNs ≥ 3 (1), +for vacuolization, toxic granulation, or Döhle bodies

  • PLT count (≤150.000/mm3) (1)

 Sepsis more common in preterm than in term neonates.
I:T ratio, abnormal PMN count and I:M ratio: the most frequent lab findings.
Most specific sings: PLTs, degenerative changes.
The higher the score, the greater the probability of NS.
Cut-off score performed better than the most accurate hematologic variable (I:T ratio).
HSS provides an objective assessment.
Many factors can affect hematologic response. Importance in combining lab + clinical data.
Emphasis on EOS rather than LOS.
Suggested as a screening test for diagnosing NS.
[31] India, 2011 Prospective Validation of HSS (by Rodwell et al.) 50 neonates: 50 episodes (12 sepsis, 26 probable infections, 12 no sepsis)
Aged 24 h–8 days (EOS and LOS), 58% term and 42% preterm, with perinatal risk factors or clinical suspicion of sepsis.

  • I:T ratio (↑) (1)

  • Total PMN count (↑/↓) (1 or 2)

  • I:M ratio (≥0.3) (1)

  • Immature PMN count (↑) (1)

  • Total WBC count (↑/↓: ≤5.000/mm3 or ≥25.000, 30.000 and 21.000 at birth, 12–24 h and day 2 onward, respectively) (1)

  • Degenerative changes in PMNs ≥ 3 (1), +for vacuolization, toxic granulation, or Döhle bodies

  • PLT count (≤150.000/mm3) (1)

 Total PMN count and immature PMN count: the most sensitive signs in sepsis.
Total WBC count, I:T ratio and PLT count: the most specific findings in sepsis.
Best PPV: I:T ratio and PLT count.
I:T ratio and degenerative changes: the most reliable variables.
The higher the score, the greater the probability of NS.
Suggested as a screening test for diagnosing NS.
[32] India, 2013 Prospective Validation of HSS (by Rodwell et al.) 110 neonates: 110 episodes (42 sepsis, 22 probable infection, 46 normal)
Age birth-1 week (EOS and LOS), 57% preterm and 43% term, with perinatal risk factors or clinical suspicion of sepsis

  • I:T ratio (↑) (1)

  • Total PMN count (↑/↓) (1 or 2)

  • I:M ratio (≥0.3) (1)

  • Immature PMN count (↑) (1)

  • Total WBC count (↑/↓: ≤5.000/mm3 or ≥25.000, 30.000 and 21.000 at birth, 12–24 h and day 2 onward, respectively) (1)

  • Degenerative changes in PMNs ≥ 3 (1), +for vacuolization, toxic granulation, or Döhle bodies

  • PLT count (≤150.000/mm3) (1)

 Immature PMN: the most sensitive variable.
I:M ratio: the most specific and the most predictive sign. I:T ratio: the most reliable indicator of sepsis.
HSS more sensitive, specific and predictive in preterm than in term neonates.
The higher the score, the higher the likelihood of NS.
Emphasis on preterm (57%) than in term.
Suggested as screening test for diagnosing NS.