SIR GANGA RAM HOSPITAL RESEARCHERS REPORT A POSSIBLE EARLY MARKER FOR DIAGNOSIS OF NEW BORN SEPSIS

MNV CRP in neonatal sepsis –Neonatal Sepsis comprises a major problem in India with septicemia and pneumonia accounting for 52 % deaths in home-cared rural born neonates.  Early detection  is challenging as clinical signs are subjective , and the gold standard , a positive blood culture , requires 1-3 days . Cases of suspected but blood-culture negative sepsis outnumber culture-positive ones by at least 15-20 times . Inexpensive diagnostic  alternatives like complete blood counts , neutrophilia , immature neutrophils and the immature-to-total  neutrophil  (IT) ratio are relatively insensitive . Other markers like C-reactive protein (CRP) , interleukin (IL)-6 , procalcitonin , calprotectin , lipopolysaccharide-binding protein , and neutrophil CD-64 expression as well as novel molecular / proteomic techniques have been investigated.

Currently diagnosis of neonatal  sepsis is made on the basis of combined equations generated from three tests that is Complete Blood Count ( CBC) , Blood Culture and CReactive Protein . The results of these are generated in 24 to 72 hours and patient is started on antibiotics pending the results.

Neonatal Sepsis is one of the diseases which is characterized by leukocytic abnormalities in the blood . Researchers from SGRH used VCS  (Volume , Conductivity and Scatter ) data generated from  automated hematology analysers LH-750 ,  for early and sensitive diagnosis of  sepsis in newborns .  VCS data are obtained from complete blood counts costing approximately Rs 200/-  ,  without any requirement of additional testing , extra sample , reagents , time,  or expenditure. We evaluated its performance as a potential marker of neonatal sepsis.

 The study setting was a busy referral neonatal intensive care unit (NICU) in a tertiary-care  teaching hospital , SGRH. After institutional Ethics Committee clearance , venous blood samples were drawn from 94 neonates aged 0-28 days admitted consecutively to the NICU in whom sepsis was suspected along with 36 gestation-matched  healthy controls with no clinical or laboratory suspicion of infection . Complete blood count and VCS parameters were obtained . Romanowsky – stained blood films were examined , and lekocyte differential count , neutrophil percentage , immature neutrophil percentages (i.e bands , metamyelocytes , myelocytes , and promyelocytes ), and IT ratio were calculated . Simultaneous blood cultures and CRP measurement were sent in all babies . Urine , CSF , and / or other site cultures were performed as necessary .

All neonates were followed up till discharge , death , or leave against medical advice .