Modified hematological sepsis score in early diagnosis of neonatal sepsis

Background: Diagnosis of neonatal sepsis at an early stage substantially reduces the mortality. The clinician often relies on laboratory parameters to support the clinical suspicion. As blood culture takes time and yield is low, hematological and biochemical parameters often guide to the diagnosis and management. Rodwell’s Hematological sepsis score (HSS) has a reasonable sensitivity but low specificity. Some of the parameters included in that scoring system are repetitive of same pathogenic mechanism. A modified HSS was developed by the authors by removing the repetitive parameters, increasing the weightage for low neutrophil count and adding a new parameter - nucleated RBC. Objective of the study was to compare the diagnostic ability of the modified hematological sepsis score with Rodwell’s hematological sepsis score.Methods: Prospective analytical study conducted in a tertiary level hospital. Neonates admitted to NICU and had complete blood count done were included. Babies with clinical signs of systemic inflammatory response syndrome and evidence of organ dysfunction were considered septic. They were classified as proven sepsis if the blood culture was positive. All the samples were scored for both HSS and modified HSS. The sensitivity, specificity and other diagnostic ability tests were compared between the two scoring systems.Results: Total of 75 neonates were enrolled. 25 of them had sepsis and three had blood culture positive. At a score of 3, the sensitivity and specificity of HSS was 80 and 70% and that of Modified HSS was 84 and 82% respectively.Conclusions: Modified hematological score improves the specificity and likelihood ratios without decreasing the sensitivity in early diagnosis of neonatal sepsis

Dilemma in diagnosis of pyogenic meningitis in cerebrospinal fluid contaminated with blood: Does leucocyte esterase test help?

Context: Pyogenic meningitis is often a devastating condition which is diagnosed by analysis of cerebrospinal fluid (CSF) obtained by lumbar puncture (LP). CSF thus obtained can get contaminated with peripheral blood leucocytes during LP which renders it unusable for cytological analysis. Leucocyte esterase strips are available for identifying leucocyte esterase activity in urine and other body fluids which suggest inflammation. We conducted this experiment to see whether the leucocyte esterase strip can differentiate between neutrophils invited at the inflammatory site and circulating neutrophils in CSF. Aim: To compare the diagnostic ability of the leucocyte esterase test between pyogenic meningitis and CSF contaminated with circulating neutrophils. Setting and Design: Prospective analytical study conducted in a tertiary care hospital. Materials and Methods: The CSF samples of pyogenic meningitis patients were analyzed for leucocyte esterase activity. The other group was normal CSF which was deliberately contaminated with buffy coat preparation, and leukocyte esterase activity was determined. Statistical Analysis: Diagnostic ability of a test in terms of sensitivity and specificity. Results: Overall sensitivity of the dipsticks in diagnosing pyogenic meningitis is 81% and specificity is 99%. When compared with experimentally contaminated CSF sample, a reading of 2+ on the strip had a sensitivity of 70% and specificity of 100% for pyogenic meningitis. Conclusion: Leucocyte esterase strip is specific for pyogenic meningitis (activated neutrophils), and hence can differentiate from CSF contaminated with blood

Sepscore- An Improved Armament in the Diagnosis of Neonatal Sepsis

Introduction: Neonatal sepsis is the third most frequent cause of neonatal mortality. Early diagnosis and treatment are very crucial for successful outcome. Blood culture, which is the gold standard for diagnosis, will not be available early for appropriate management. Haematological Sepsis Scoring (HSS) is a rapid, low-cost sensitive lab tool for diagnosing neonatal sepsis. Modification of HSS (Sepscore) done by removal of repetitive parameters and addition of Neonate Red Blood Cells (nRBC) which are elevated in sepsis, have higher specificity. Aim: To compare the diagnostic utility of the modified HSS (Sepscore) with Rodwell’s HSS. Materials and Methods: The prospective analytical study was conducted over 18 months in a tertiary care hospital in South India blood samples of 350 neonates admitted to Neonatal Intensive Care Unit (NICU) with signs of sepsis were evaluated by HSS and Sepscore. The sensitivity, specificity, predictive values and likelihood ratios of Sepscore and cut-off value of the Sepscore using the Receiver Operating Characteristic (ROC) curve for diagnosis of neonatal sepsis was determined. Results: A total of 146 of 350 (41.7%) had neonatal sepsis and rest served as controls. A total of 188 (53.7%) of our subjects were preterm. The cut-off was determined as three for both HSS and Sepscore. The sensitivity and specificity of HSS were 71% and 54% whereas that of Sepscore was 68% and 61%, respectively. The diagnostic ability of Sepscore was found to be significantly higher than that of HSS (p=0.0094). Conclusion: Sepscore has a higher specificity and marginally lower sensitivity compared to the HSS in neonatal sepsis