Sarah Ali Arif, Ayesha Ehsan, Mizna Arif, Javaid Hussain, Rahila Bano


Background: Neonatal sepsis is a common occurrence in our part of the world characterized by signs and symptoms
of bacterial infection during first 28 days of life. This study was carried out to evaluate the hematological
parameters and C-reactive protein estimation in combination for early diagnosis in patients with neonatal sepsis.
Material & Methods: This cross sectional study was conducted at the Pediatrics Department, District Headquarters
Hospital, Dera Ismail Khan, from October 2008 to April 2009. Seventy-five neonates having clinical
features of sepsis and 35 clinically normal (asymptomatic) neonates were evaluated with a set of investigations.
Total leukocyte count (TLC) absolute neutrophil count (ANC) platelet count (PLT) and C-reactive protein (CRP)
estimation were used for diagnosis of neonatal sepsis.
Results: TLC had sensitivity of 75% for group A (proven sepsis) and 76% for group B (probable sepsis); and
had a negative predictive value (NPV) of 80% and 65% respectively. The sensitivity of ANC was 65% and 76%
in group A and B respectively. For proven sepsis, the sensitivity of CRP was 75% and 76% for probable sepsis.
The sensitivity and NPV for the combination of TLC, ANC and CRP were 100% each in group A and 79% and
80% in group B.
Conclusion::The combination of TLC, ANC and CRP is more sensitive in detection of culture positive than culture
negative cases of neonatal sepsis.


Neonatal sepsis; Culture; TLC; CRP

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Adams CI, Stoll BJ. Systemic inflammatory

response syndrome. Pediatr Infect Dis 2001;


Movahedian AH, Moniri R, Mosayebi Z. Bacterial

culture of neonatal sepsis. Iranina J Publ Health

; 35: 84-9.

Aurangzeb B, Hameed A. Neonatal sepsis in hospital

born babies: bacterial isolates and antibiotics

susceptibility patterns. J Coll Physicians Surg Pak

; 13:629-32.

Ahmed Z, Ghafoor T, Waqar T, Ali S, Shahid A,

Mahmud S. Diagnsoitc value of C-reactive protein

and haematological parameters in neonatal

sepsis.JColl Physicians Surg Pak 2005; 15:152-6.

Goldenberg RL, Hauth JC, Andrews WW. N Engl

J Med 2000; 342:1500-7.

Yoon BH, Romero R, Moon JB. Clinical significance

of intra-amniotic inflammation in patients

with preterm labor and intact membranes. Am J

Obstet Gynaecol 2001; 185:1130-6.

Sohn AH, Garrett DO, SinkowitzRL.Prevalence of

nosocomial infections in neonatal intensive care

unit patients. J Pediatr 2001; 139:821-7.

Robertson CM, Coopersmith CM. The systemic

inflammatory response syndrome. Microbes

Infect 2006; 8:1382–9.

Ghosh S, Mittal M, Tajanathan G. Early diagnosis

of neonatal sepsis using a hematological scoring

system. Indian Pediatr 2000; 54:495-500.

Escobar GJ. The neonatal sepsis workshop

personal reflections on the development of an

evidence based approach towards newborn

infection in a managed care organization. Paediatrics

; 103:360-73.

Levy MM, Fink MP, Marshall JC, Abraham E, Angus

D, Cook D, et al. International Sepsis Definitions

Conference. Crit Care Med 2003; 31;1250–6.

Mustafa S, Farooqui S, Waheed S, Mahmood K.

Evaluation of C-reactive protein as early indicator

of blood culture positivity in neonates. Pak J Med

Sci 2005; 21:69-73.

Chiesa C, Panero A, Osborn JF, Simonetti AF,

Pacifico L. Diagnosis of neonatal sepsis: A clinical

and laboratory challenge. Clin Chem 2004;


Polin RA. The ins and outs of neonatal sepsis. J

Pediatr 2003; 143:3-4.

Pourcyrous M, Bada HS, Korones SB, Baselski V,

Wong SP. Significance of serial C-reactive protein

responses in neonatal infection and other disorders.

Pediatrics 1993; 92:431-5.

Manucha V, Rusia U, Sikka M, Faridi MM, Madan

N. Utility of hematological parameters and C-reactive

protein in the detection of neonatal sepsis.

J Paediatr Child Health 2002; 38:459-64.

Sharma A, Kutty CV, Sabharwal U, Rathee S, Mohan

H. Evaluation of sepsis screen for diagnosis

of neonatal septicemia. Indian J Pediatr 1993;


Bataineh HA, Al-Rashed KM. C-reactive protein in

neonates with suspected septicemia. Rawal Med

J 2007; 32:24-6.

Berger C, Uehlinger J, Ghelfi D, Blau N, Fanconi S.

Comparison of C-reactive protein and white blood

cell count with differential in neonates at risk for

septicemia. Eur J Pediatr 2005;154:138-44.

Schelonka RL, Bradley YA, Desjardins SE. Peripheral

leukocyte count and leukocyte indexes

in healthy newborn term infants. J Pediatr 1994;


GerdesJS, Polin RA. Newonatal septicemia. In:

Burg FD, Ingelfinger JR, Polin RA. Editors. Gellis&

Kagan’s Current Pediatric Therapy. Volume

Philadelphia: WB Saunders 2002;347-51.

Anwer SK, Mustafa S. Rapid identification of

neonatal sepsis. J Pak Med Assoc 2000; 50:94-8.

Christensen RD, Rothstein G, Hill HR. Fatal early

onset group B streptococcal sepsis with normal

leukocyte counts. Pediatr Infect Dis J 1985; 4:242-

Arshad A, Asghar I, Tariq MA. Role of serum C-reactive

protein in the rapid diagnosis of neonatal

sepsis. Pak Armed Forces Med J 2003; 53:178-82.

Benitz W, Han M, Madan A. Serial serum C-reactive

protein levels in the diagnosis of neonatal

infection. Pediatrics 1998; 102: e41.

Hengst JM. The role of C-reactive protein in the

evaluation and management of infants with suspected

sepsis. Adv Neonatal Care 2003; 3:3-13.

Nuntnarumit P, Pinkaew O, Kitiwanwanich S.

Predictive values of C-reactive protein in neonatal

sepsis.J Med Assoc Thai 2002;85:1151-8.

Russell G, Smyth A, Cooke R. Receiver operating

characteristic curves for comparison of serial

neutrophil band forms and C-reactive protein

in neonates at risk for infection. Arch Dis Child


Chiesa C, Pellegrini G, Panero A. C-reactive protein,

postnatal period: influence of illness severity,

risk status, antenatal and perinatal complications

and infection. Clin Chem 2003; 49:51-9.


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