Diagnostic Accuracy of Haematological Scoring System (HSS) in Neonatal Sepsis: A Facility Based Cross-Sectional Study

Abstract

Objectives: The aim of the present study was to determine the diagnostic accuracy of Haematological scoring System (HSS) in neonatal sepsis. Methods: This was a laboratory based cross-sectional study conducted in the Department of Pathology, Vinayaka Missions Medical College & Hospital, Karaikal, Puducherry, India (tertiary healthcare facility) in south India between January 2023 and August 2023 among neonates presenting with features suggestive of sepsis (n = 145). Results: More than half (57.9%) the neonates were males; and 55.2% were between 1 and 7 days of age. The distribution of normal vaginal and caesarean delivery was 42.1% and 57.9% respectively. More than half (54.5%) the neonates were born with birthweight ranging between 1500 and 2499 grams; and 10.3% were born with birthweight less than 1500 grams. In terms of gestational age, 53.1% neonates included were born preterm. Refusal to feed was the most common (58.6%) presenting complaint. The results of peripheral smear showed that 91.7% neonates had neutrophilia, 37.9% had degenerative neutrophilic changes, 17.2% had thrombocytopenia, 13.8% had leucocytosis, 11.0% had nucleated RBCs (>5/100 WBCs) and 2.1% had leukopenia. One in four samples were positive for c-reactive protein (26.9%). Importantly, the number of samples found positive in blood culture was 30.3%. The results showed that the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of c-reactive protein in comparison with blood culture results were 54.5%, 85.1%, 61.5% and 81.1% respectively. The diagnostic accuracy of haematological scoring system was assessed with two cutoff points – with 5 as cutoff, the sensitivity was 13.6%, specificity was 100%, PPV was 100% and NPV was 72.7; and with 4 as cutoff, the sensitivity, specificity, PPV, and NPV were 90.9%, 62.4%, 51.3% and 94.0% respectively. Conclusion: The HSS, with adjustable cutoff points, allows for a tailored diagnostic approach, balancing sensitivity and specificity based on clinical priorities.