Publication:

Changing role of neonatal sepsis markers in the era of BacT/Alert: is there a need to devise a new septic screen

Background Emergence of newer culture methods and other diagnostic aids for neonatal sepsis makes evaluation of known sepsis markers imperative to define their changing role. This study was designed to assess role of CRP, leukopenia, neutropenia and thrombocytopenia in neonatal sepsis in this changing era.

Methods A prospective observational study was conducted in a level-3 NICU in north India in 2013. Study duration was 1 year. All patients visiting our hospital with non-specific symptoms and signs suggestive of sepsis were admitted and evaluated. Neonates with confirmed sepsis were allotted to cases group and others to control group. CBC and CRP were taken from both groups; sensitivity, specificity, negative and positive predictive value of leucopenia, neutropenia and thrombocytopenia were assessed. Relationship of these markers with neonatal mortality was also assessed. Statistical analysis used was Graphpad Instat statistical software was used for analysis. Comparisons were made by chi-square test and Fischer’s exact test. A p-value <0.05 was taken as significant.

Results 120 neonates had confirmed sepsis and 76 were in the control group. CRP had sensitivity, specificity, negative and positive predictive values of 67%, 19%, 27% and 57%. Sensitivity, specificity, negative and positive predictive values for leukopenia were 22%, 68%, 29% and 59%, respectively. For neutropenia and thrombocytopenia these values were 16%, 81%, 34% and 61% and 41%, 71%, 42% and 70%, respectively. These markers also bore a significant association with mortality in both cases and controls (p-Value <0.05).

Conclusions Haematological parameters are poor screening tools for neonatal sepsis; however they have a definite role as prognostic indicators. CRP appears to be a good screening tool for sepsis; however its low sensitivity is a drawback. There is a need to combine CRP with other markers like procalcitonin in newer septic screens to aid early diagnosis of neonatal sepsis.