White Blood Cells and Platelets Indices as a Prognostic Factor in Neonatal Sepsis

2019-03-22 06:26:19 | BioPortfolio


Sepsis is a complex condition initiated by a pathogen and mediated by cytokines followed by immune, inflammatory, and coagulation homeostasis disturbances, its evolution being dictated by a complicated balance between pro inflammatory and anti- inflammatory factors. Most of the short and long-term complications of the neonatal sepsis are strictly related to inflammatory mediators. Neonatal sepsis is associated with a mortality rate that ranges from 13 to 60% inspite of improved antibiotic therapy and an increased morbidity in survivors .


"Suspected sepsis" is one of the most frequently encountered diagnosis in neonatology because: a) a large number of newborns are evaluated for early or late sepsis based on risk factors and for fear of missing a correct diagnosis and a prompt treatment ; b) in neonates, the clinical signs of infection are not specific, late, and the differential diagnosis with neonatal respiratory distress syndrome, aspiration syndromes or neonatal maladaptation to extra-uterine life is difficult ; c) blood culture - the golden standard in neonatal sepsis diagnosis - provides late information, has a poor accuracy, and is not universally available; and d) up to date, there is no an ideal diagnostic tool for neonatal infection . Therefore, diagnosis of neonatal sepsis is still a challenge for neonatal medicine.

Antibiotic therapy is often initiated based upon clinical suspicion and/or the presence of risk factors, leading to excessive antibiotic therapy. Very often the diagnosis criteria for neonatal sepsis consists in documenting an infection in a newborn with severe systemic disease in which all possible noninfectious explanations for the patient's altered physiological status are either ruled out or unlikely.

The "gold standard", definitive test for neonatal sepsis is the isolation of the pathogen from blood. However, its accuracy is influenced by multiple factors a) contamination during sampling; b) sampling after antibiotic therapy was started; c) insufficient sampling volume; d) low colony count bacteremia. Accuracy of the blood culture varies between8 and 73% in various studies .

Despite hundreds of published studies, there is still no consensus regarding the best screening test or panel of tests for rapid detection of neonatal sepsis. Recently, new acute phase proteins, cytokines, cell surface antigens, and bacterial genome are used to improve the neonatal sepsis diagnosis but data are still under evaluation and most of these tests are either not clinically available or they are expensive .

Accumulating evidence indicates that the CBC is an effective predictor of prognosis and mortality in many disease states, including hematological disease, neoplasms, and severe infections. Therefore, non- specific changes in the CBC in critically ill neonates could be considered a key prognostic factor in the evaluation of survival prediction in these patients .

Some prognostic scoring systems with performance status, clinical symptoms and biochemical parameters help to guide accurate prediction of the prognosis, such as the acute physiology and chronic health evaluation, yet are considered too complex for general clinical use. Therefore, the prediction of clinical events with laboratory parameters, including complete blood cell count (CBC), has become an increased focus of research .

Total leukocyte count (TLC), total neutrophil count, ANC, immature neutrophil count, immature/total neutrophil ratio (I:T ratio), immature/mature neutrophil ratio (I:M ratio), neutrophil degenerative changes (vacuolization, toxic granulations, and Döhle bodies), and platelet count are the most used hematological parameters for Early Onset Sepsis evaluation . Most of the hematological screening panels for Early Onset Sepsis use a total leukocyte count < 5000 cells/mm3 or > 20.000 cells/mm3, an I:T ratio > 0.2, and total outside the normal range. TLC increases in severe neonatal infections (both mature and immature cells) possible secondary to growth factors and cytokine release that stimulate the bone marrow production.

Thrombocytopenia is one of the early but non-specific indicator of neonatal sepsis with or without DIC. It can be caused by bacterial, viral, fungal and parasitic infections and other non-infectious causes. The overall prevalence of thrombocytopenia in neonatal age group varies from1- 5%, and is reported to be much higher in newborns admitted to intensive care units, i.e. ranging from 22% to 35%. Severe thrombocytopenia (50000/mm3) was found to be present in 2.4% patients admitted in NICU.Bleeding is a major complication of thrombocytopenia but is generally limited to infants with count< 30000/mm3. Studies have shown that approximately 50% cases of culture proven of sepsis get thrombocytopenia .Changes in other platelet indices, like MPV(mean platelet volume) and PDW (platelet distribution width) have also been examined in relationship to neonatal sepsis in some studies .

Platelet indices (platelet counts, platelet distribution width-(PDW), mean platelet volume (MPV)) are one such set of parameters which can be helpful for the diagnosis and hence early treatment of neonatal sepsis. Advantages of platelet indices are that the sample for these can be drawn at the same time as that for other investigations and require no special sampling techniques and are easily available. Some studies had reported a low platelet counts, high mean platelet volume and platelet distribution width was observed in sepsis cases with a statistically significant difference as compared to controls .

Study Design


Neonatal Sepsis


complete blood count


Eslam Ahmad Roshdy


Not yet recruiting


Assiut University

Results (where available)

View Results


Published on BioPortfolio: 2019-03-22T06:26:19-0400

Clinical Trials [1402 Associated Clinical Trials listed on BioPortfolio]

Epidemiology of Neonatal Sepsis in Neonatal Intensive Care Unit in Assiut University Children Hospital

Neonatal sepsis is an important cause of morbidity and mortality in the pediatric age group . It is one of the leading causes of death in the first 28 days of life both in the developed an...

Prognostic Value of Red Cell Distribution Width (RDW) in Neonatal Sepsis

1. Evaluate the relationship of RDW and severity and mortality in patients with neonatal sepsis . 2. Using RDW as a simple, inexpensive, applicable and rapid test to detect prognos...

Prognostic Value of Complete Blood Count in Severe Infections

Sepsis is a leading cause of hospitalization in pediatric intensive care units, In the last decade, a series of initiatives were implemented that aim not only to improve the understanding ...

Neonatal Sepsis Diagnosis: ; PCR Commercial Technique and Blood Culture

Although advances in neonatal care have improved survival and reduced complications in preterm infants, sepsis still contributes significantly to mortality and in Neonatal Intensive Care U...

NeoAMR Observational Study in Neonatal Sepsis

Prospective, multinational, multicentre, observational cohort study of neonatal sepsis in partner institutions. The cohort study will be designed to evaluate health care utilization and cu...

PubMed Articles [9115 Associated PubMed Articles listed on BioPortfolio]

Pentraxin 3 as a novel diagnostic marker in neonatal sepsis.

Neonatal sepsis is an important cause of morbidity and mortality especially in developing countries. As clinical manifestations of neonatal sepsis are nonspecific, early diagnosis and treatment remain...

Implementation of the Neonatal Sepsis Calculator in Early-Onset Sepsis and Maternal Chorioamnionitis.

Utilization of the neonatal sepsis calculator published by Kaiser Permanente is rapidly increasing. This freely available online tool can be used in assessment of early-onset sepsis (EOS) in newborns ...

The role of the season at admission in neonatal sepsis: a retrospective chart review of a 1-year data at University of Gondar comprehensive specialized hospital.

Neonatal sepsis is a global public health concern in general and causes a massive burden in developing countries particularly in sub-Saharan Africa. Though it is mostly preventable, neonatal sepsis re...

An Unknown Risk Factor for Sepsis in Very Low Birth Weight Preterms: ABO Blood Groups (BGaPS Study).

 There is insufficient study of the association of blood groups with neonatal diseases. The aim of this study was to evaluate the blood groups associated with sepsis and blood groups in preterm infa...

Factors Affecting Human Umbilical Cord Blood Quality Before Cryopreservation: The Importance of Birth Weight and Gestational Age.

Umbilical cord blood (UCB) is a rich source of hematopoietic stem cells and is useful for the treatment of blood diseases. The cost of UCB storage is high; thus, it is necessary to evaluate the qualit...

Medical and Biotech [MESH] Definitions

Blood infection that occurs in an infant younger than 90 days old. Early-onset sepsis is seen in the first week of life and most often appears within 24 hours of birth. Late-onset occurs after 1 week and before 3 months of age.

The number of LEUKOCYTES and ERYTHROCYTES per unit volume in a sample of venous BLOOD. A complete blood count (CBC) also includes measurement of the HEMOGLOBIN; HEMATOCRIT; and ERYTHROCYTE INDICES.

Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by HYPOTENSION despite adequate fluid infusion, it is called SEPTIC SHOCK.

Acute neurological dysfunction during severe SEPSIS in the absence of direct brain infection characterized by systemic inflammation and BLOOD BRAIN BARRIER perturbation.

The number of WHITE BLOOD CELLS per unit volume in venous BLOOD. A differential leukocyte count measures the relative numbers of the different types of white cells.

More From BioPortfolio on "White Blood Cells and Platelets Indices as a Prognostic Factor in Neonatal Sepsis"

Quick Search

Relevant Topics

Antiretroviral Therapy Clostridium Difficile Ebola HIV & AIDS Infectious Diseases Influenza Malaria Measles Sepsis Swine Flu Tropical Medicine Tuberculosis Infectious diseases are caused by pathogenic...

Biological Therapy
Biological therapy involves the use of living organisms, substances derived from living organisms, or laboratory-produced versions of such substances to treat disease. Some biological therapies for cancer use vaccines or bacteria to stimulate the body&rs...

Pediatrics is the general medicine of childhood. Because of the developmental processes (psychological and physical) of childhood, the involvement of parents, and the social management of conditions at home and at school, pediatrics is a specialty. With ...

Searches Linking to this Trial