Use of the Complete Blood Cell Count in Early-onset Neonatal Sepsis
The Pediatric Infectious Disease Journal, 07/27/2012
Hornik CP et al. – Low white blood cell count, absolute neutrophil count and high immature–to–total neutrophil ratio were associated with increasing odds of infection, but no complete blood cell count–derived index possesses the sensitivity to rule out reliably Early–onset sepsis (EOS) in neonates.Methods
- Using a cohort of 166,092 neonates with suspected EOS with cultures admitted to 293 neonatal intensive care units, they calculated odds ratios and receiver operating characteristic curves for complete blood cell count indices and prediction of a positive culture.
- They determined sensitivity, specificity and likelihood ratios for various commonly used cutoff values from the complete blood cell count.
- Low white blood cell counts, low absolute neutrophil counts and high immature-to-total neutrophil ratios were associated with increasing odds of infection (highest odds ratios: 5.38, 6.84 and 7.97, respectively).
- Specificity and negative predictive values were high (73.7%–99.9% and >99.8%). However, sensitivities were low (0.3%–54.5%) for all complete blood cell count indices analyzed.