Hematological indices as early predictors of neonatal sepsis

Background Neonatal sepsis is a cause of substantial morbidity and mortality. Early-onset neonatal sepsis (EOS) occurs within the first 72 h of age and has nonspecific manifestations and inaccurate biomarkers that may lead to delay in diagnosis, delay in therapy initiation, unnecessary hospital admissions, and antibiotic misuse. Objective This study aims to calculate ratios of different hematological indices obtained from complete blood counts and assess their role in the prediction of EOS. Patients and methods This is a case–control study conducted on 156 neonates who were admitted to the neonatal intensive care units. Hematological ratios including neutrophils: lymphocytes ratio, platelets: lymphocytes ratio, platelets: hematocrit ratio, platelets: total leucocytic count ratio, platelets: total polymorph nuclear leucocytes (PMN) ratio, platelets: mature PMN and platelets: immature PMN ratio were calculated from the complete blood count. Results The study showed that 37.2% of cases had thrombocytopenia compared to seven (9.0%) of the control group ( P <0.001). It was found that the platelets: immature PMN ratio was significantly higher in neonates with EOS. However, we did not find an association between the platelets: lymphocytes ratio or any of the other ratios and EOS. Receiver operator characteristic analysis for platelets: immature PMN ratio revealed a diagnostic cut-off value of 337.34 with 73.08% sensitivity and 50% specificity. Conclusion The platelets to immature PMN cells ratio decreases significantly in EOS and can be used as a marker for diagnosis.