C-Reactive Protein, Immature to total Neutrophil Ratio and Micro ESR in early diagnosis of Neonatal Sepsis

Abstract

Neonatal Sepsis is a clinical syndrome characterized by signs and symptoms of infection, identified & confirmed by positive blood cultures. As per National Neonatal Perinatal Database (NNPD) 2002-2003, the incidence of neonatal sepsis in India was 30 per 1000 live birth. Systemic bacterial infection is known by the term neonatal sepsis which incorporates septicemia, pneumonia and meningitis. C-reactive protein (CRP), an acute phase reactant has advantages of low serum levels in normal infants, a rapid rise after 12 to 24 hours of sepsis and a massive rise thereafter as long as inflammatory stimuli persist and followed by immediate fall of serum level as soon as inflammation subside. Micro ESR can be compared to wintrobe's method of doing ESR and can be used in neonatal sepsis. Rates do not vary considerably with gestational age, birth weight, but are inversely related to hematocrit level, Particularly when it is less than 40 mm/dl. The micro ESR is generally mildly elevated in non infectious conditions. In most of the patients with infection the micro ESR is elevated within 24 hours of infection and it is not influenced by antibiotic. It is well-known fact that understanding hematology of neonatal sepsis helps in early identification of suspected cases of neonatal sepsis. Amongst Hematological parameters Immature to total neutrophil (I:T) ratio has a reasonably good predictive value for early diagnosis of neonatal septicemia. This study is done as an endeavor to add to something about our preexisting knowledge of ''diagnosis of neonatal sepsis'' early for better management of this group of patients.