Diagnostic Efficacy of Nucleated Red Blood Cells in Neonatal Sepsis at A Tertiary Care Hospital

Author(s): Dr. Surjeet Kumar Shukla, Dr. Tankeshwar Prasad Patel, Dr. Gayatri Joram, Dr. Shweta Soorauthiya*

Background: The most common cause of neonatal mortality in the developing countries is neonatal sepsis. Neonates with sepsis show excess Nucleated RBC (NRBC’s) in peripheral blood, which correlates with adverse outcome. Newer studies reveal that elevated NRBCs levels in neonatal sepsis help in predicting an adverse neonatal outcome and thus can improve the care by prioritizing them.

Material and Method: All newborns, delivered in Chirayu Medical college and hospital and out born babies fulfilling the inclusion criteria were included in the study. Study design was cross sectional study. The study included the neonates with clinical suspicion of sepsis at birth, within 72 hours and history of infection was present in the mother. Data of the neonates with clinical suspicion of sepsis admitted to the NICU were collected. A thin blood film was prepared and air dried. The slide was flooded with stain. On peripheral smear nRBCs were counted per 100 WBCs, immature granulocytes, toxic granules in neutrophils, platelet counts and B:N ratio were noted. A P-value less than 0.05 was taken to be statistically significant.

Result and Discussion: The mean NRBC in culture positive cases was 19.73, in clinical sepsis it was 13.17 and 6.42 in no sepsis group and the difference was found to be statistically significant. In our NRBC score of >10/100WBC in our study was 87.1%. In this present study the sensitivity of NRBC in identifying sepsis was 78.5%, its specificity was 59.25%, positive predictive value was 71.25% and negative predictive value was 76.23%.

Conclusion: Estimation of NRBC on day 1 in suspected neonatal sepsis can predict sepsis earlier. The difference of NRBC count in sepsis and no sepsis group was found to be significant. NRBC can be an early marker of sepsis along with the septic screen, that is cost effective, rapid, simple tool for early diagnosis and intervention. NRBC count can be helpful in assessing prognosis of sepsis and response to therapy. It can be a better predictor of mortality in neonatal sepsis.