Early diagnosis of neonatal sepsis using a hematologic scoring system

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Hematologic findings and published complete blood cell count criteria were evaluated as screening tests for neonatal sepsis. From the data obtained, a hematologic scoring system was formulated that assigns a score of 1 for each of seven findings: abnormal total leukocyte count, abnormal total neutrophil (PMN) count, elevated immature PMN count, elevated immature to total PMN ratio, Immature to mature PMN ratio ≥0.3, platelet count ≤150,000/mm3, and pronounced degenerative changes in PMNs. There were 298 evaluations for sepsis (243 in the first 24 hours of life and 55 between days 2 and 30). Twenty-six of 27 (96%) infants with sepsis and all 23 infants with probable infection had scores ≥3, compared with 35 of 248 (14%) noninfected infants. The likelihood of sepsis with score ≥3 was 31%, and this value differed with both gestational and postnatal ages (34% vs 8% in preterm and term infants <24 hours of age, and 65% thereafter). The higher the score the greater was the likelihood of sepsis. With score ≤2 the likelihood that sepsis was absent was 99%. The hematologic scoring system should improve the diagnostic accuracy of the complete blood cell count as a screening test for sepsis and could simplify and standardize the interpretation of this global test.

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