A clinicopathological study of thrombocytopenia, acute-phase reactants, and blood culture in neonatal sepsis

Abstract

Introduction: Neonatal sepsis is a clinical syndrome described as any systemic bacterial infection in neonates documented by positive blood culture. However, blood culture is positive in only 5.0%–10.0% of suspected cases. Serum concentration of many acute-phase reactants rises in response to infection, which can be used as a non-specific indicator of bacterial sepsis. Aim and Objectives: The aim of this study was to correlate the levels of serum markers C-reactive protein (CRP), serum ferritin, and thrombocytopenia with neonatal sepsis. Materials and Methods: This was a prospective cross-sectional study conducted in the Neonatal Intensive Care Unit, Department of Paediatrics and Pathology, Jawaharlal Nehru Medical College (JNMC), Aligarh from 2019 to 2021 on 172 babies (cases =142; controls = 30). Neonates with sepsis who presented with clinical signs or symptoms of sepsis were taken as case group and healthy neonates served as control. Result: Blood culture was positive in 58 (40.8%) neonates in the case group and Klebsiella was present in maximum number of cases. Blood culture was positive in only 8 (13.8%) cases out of 31 cases of mild thrombocytopenia. The total culture-positive organism was 58 (40.8%), with 09 (15.5%) gram-positive, 46 (79.3%) gram-negative organisms, and 03(5.2%) fungus. Positive CRP was seen in 88 (61.9%) neonates in the case group, out of which, positive culture was noted in 38 (65.5%) neonates and negative in 50 (59.5%) neonates. Serum ferritin values >400 µgm/L was seen in 97 (68.3%) neonates in the case group and 6 (20.0%) neonates in control group. The mean serum ferritin in culture positive neonates was 1024 ± 309 µgm/L and in culture-negative neonates was 999 ± 301 µgm/L. Conclusions: The signs and symptoms of neonatal sepsis are non-specific, leading to difficulty in diagnosis and treatment. Biomarkers such as hematological indices, blood culture, and acute-phase reactants could be more reliable in rapid evaluation and early diagnosis of sepsis and may provide a new diagnostic strategy for the neonates with sepsis.