Publication:

Gastric aspirate cytology as a screening tool for neonatal sepsis: a prospective study from a tertiary care centre

Background Neonatal sepsis is a clinical syndrome of bacteremia characterized by systemic signs and symptoms of infection in the first 28 days of life. It is responsible for 30-50% of the total neonatal deaths each year in developing countries. Gastric aspirate cytology has been used for neonatal infection. The presence of more than five polymorphs per high power field co-relate with neonatal infection. The objective of the present study was to evaluate the utility of gastric aspirate cytology as a screening tool for neonatal sepsis and to determine the polymorphonuclear leukocytes count in smear of gastric aspirate and correlating it with culture proven sepsis.

Methods This prospective observational study was conducted from February 2017 to January 2018 at level III Neonatal intensive care Unit of Sri Venkata Sai Medical College and Hospital, Mahabubnagar, Telangana. A total of 108 neonates with risk factor and / or clinical features of sepsis were included in the study.

Results Out of 108 neonates, 40 were blood culture positive   and 68 were culture negative. Gastric aspirate smear showed ≥5 polymorphs in 30 and <5 polymorphs in 10 neonates with positive blood culture. Among blood culture negative cases, 20 had ≥5 polymorphs and 48 had <5 polymorphs in gastric aspirate smear. Gastric aspirate culture was positive in 48 neonates and negative in 60 neonates. Of the 48 gastric aspirate positive neonates, 45 had ≥5 polymorphs and 3 had <5 polymorphs in gastric aspirate smear. Similarly, among 60 gastric aspirate culture negative neonates, 55 had ≥5 polymorphs and 3 had <5 polymorphs in gastric aspirate smear. This was statistically significant (P<0.000001). Of 48 neonates with positive gastric aspirate culture, 30 had positive blood culture and 18 had negative blood culture.

Conclusions Gastric aspirate cytology is a good screening tool for neonatal sepsis added to a detailed perinatal history and clinical examination but does not completely substitute the present day available screening parameters.