Can we rely on the neutrophil left shift for the diagnosis of neonatal sepsis ? : need for re-evaluation
Author
Source
Egyptian Pediatric Association Gazette
Issue
Vol. 66, Issue 1 (31 Mar. 2018), pp.22-27, 6 p.
Publisher
Egyptian Pediatric Association
Publication Date
2018-03-31
Country of Publication
Egypt
No. of Pages
6
Main Subjects
Topics
Abstract EN
Background : Neonatal sepsis cause significant morbidities and mortality among affected neonates.
The gold standard for its diagnosis is the blood culture.
However, its usefulness is limited by many factors.
A rapid diagnostic test with high sensitivity and specificity is needed for rapid identification of neonatal sepsis without exposing unaffected neonates to antibiotic therapy.
The accuracy of immature neutrophil count for the diagnosis of neonatal sepsis is controversial.
Objective : Being rapid, simple and readily available, this study aimed to re-evaluate the usefulness of neutrophil left shift for the diagnosis of neonatal sepsis and assess its prognostic value in reflecting the patients’ outcome.
Methods : This prospective cross-sectional study included 285 neonates admitted to the neonatal intensive care unit, Cairo University.
Demographic, clinical and laboratory data were collected including complete blood pictures with manual differentials and blood culture results.
The diagnostic accuracy of neutrophil left shift was done through applying multiple logistic regression and receiver operating characteristic [ROC] curve.
Results : Among the study group, 61.4% had definite sepsis while 12.3% had probable sepsis.
The median immature to total neutrophil ratio (I/T ratio) was 0.25, IQR 0.21, range 0.03–0.8.
I/T ratio 0.2 was present in 65.6% of the patients and had significantly increased odds of infection, sensitivity (82.4%), specificity (81.3%), positive predictive value (92.5%) and negative predictive value (62.2%).
By plotting neutrophil left shift against blood culture, total white blood cell count (WBC) and platelet count in a ROC curve and calculating areas under the curve (AUC), it proved to be a good diagnostic test (AUC : 0.861) while total WBC count (AUC: 0.515) and platelet count (AUC: 0.366) had poor diagnostic accuracy.
Conclusion : Neutrophil left shift is a rapid, simple and readily available test that has a reasonable positive predictive value and specificity which denotes its usefulness in the early diagnosis of neonatal sepsis as well as in decreasing the exposure of non-septic neonates to antimicrobial therapy
American Psychological Association (APA)
Said, Daliyah A.. 2018. Can we rely on the neutrophil left shift for the diagnosis of neonatal sepsis ? : need for re-evaluation. Egyptian Pediatric Association Gazette،Vol. 66, no. 1, pp.22-27.
https://search.emarefa.net/detail/BIM-783218
Modern Language Association (MLA)
Said, Daliyah A.. Can we rely on the neutrophil left shift for the diagnosis of neonatal sepsis ? : need for re-evaluation. Egyptian Pediatric Association Gazette Vol. 66, no. 1 (Mar. 2018), pp.22-27.
https://search.emarefa.net/detail/BIM-783218
American Medical Association (AMA)
Said, Daliyah A.. Can we rely on the neutrophil left shift for the diagnosis of neonatal sepsis ? : need for re-evaluation. Egyptian Pediatric Association Gazette. 2018. Vol. 66, no. 1, pp.22-27.
https://search.emarefa.net/detail/BIM-783218
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references : p. 27
Record ID
BIM-783218