A Study to Determine the Role of Hematological Profile, Scoring System, and CRP in Early Diagnosis of Neonatal Sepsis

Objective: The objective of the study was to study the hematological parameters according to Rodwell’s Hematological Scoring System (HSS) in neonatal sepsis, to evaluate the efficacy of hematological parameters in the diagnosis of neonatal sepsis, and also to correlate the levels of C-reactive protein (CRP) with degree of neonatal sepsis. Neonatal sepsis is the most important cause of morbidity and mortality, especially among low-birth-weight and preterm babies in developing countries. According to the WHO, out of 4 million neonatal deaths all over the world annually, over 35% are due to infections in neonates and 99% of them occur in developing countries. The incidence of neonatal sepsis in India according to the data from the National Neonatal Perinatal Database (NNPD, 2002-03) is 30/1000 live births. The incidence is 10 times higher in infants with birth weight <1000 g. Methods: The present study was carried out in Guru Gobind Singh Medical College and Hospital, Faridkot (Punjab) located in the northern part of India over a period of 1 year on all the neonates with clinical suspicion of sepsis admitted in Neonatal Intensive Care Unit (NICU). Results: When distributed according to HSS, majority (37%) of neonates had score ≥5 followed by 33% with score 3 or 4 and 30% had score ≤2. In the present study, among 37 neonates with HSS score ≥5, 89.18% were CRP positive and 10.82% were CRP negative, followed by 33 with score ≤2 out of which 42.42% were CRP positive and 57.58% were CRP negative and 30 had score 3 or 4 among them 80% were CRP positive and 20% were CRP negative. Majority of them 76 (76.00%) showed either increased or decreased levels of polymorphonuclear neutrophils count (PMN) count and 24 (24.00%) showed PMN count within normal range. Among 76 neonates with increased or decreased levels of PMN count, majority (63.00%) showed neutrophilia, while only (13.00%) showed neutropenia. In this study, more than half of the neonates 59 (59.00%) had shown raised levels of immature PMN count. Forty-seven percent had shown an increased I: T ratio and 53% had normal I: T ratio. Only 9% of the neonates admitted to NICU with clinical suspicion of sepsis had an increased I: M ratio. Morphological degenerative changes were seen in 65 out of 100 neonates. In CRP-positive neonates, these degenerative changes were seen in 77.46% of neonates, while in CRP-negative neonates, only 31.07% showed these changes. Among 100 neonates, 77 (77.00%) had normal platelet count and 23 (23.00%) had shown decreased platelet count. Conclusion: HSS helps effectively to make choices with respect to wise utilization of anti-microbial treatment which will be life sparing, give early cure, reduce mortality, shorten the hospital stay, and as well as will minimize the risk of emergence of resistant organisms due to misuse of antibiotics as well.