الفهرس 
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Abstract
Neonatal sepsis is one of the major causes of morbidity and mortality in
newborns. Early onset neonatal sepsis (EONS) is a severe disease and has high
mortality rate. The clinical signs of EONS are nonspecific and the confirmation of
diagnosis may consume time. Therefore, the diagnostic approach is necessary by
considering the risk factors.
Hematological parameter is superior in comparison to another in predicting
neonatal sepsis, a combination of these parameters in the form of hematological sepsis
score (HSS) has been recommended. However, the neutrophil to lymphocyte ratio,
because it combines neutrophils and lymphocytes in the calculation, is considered
comparatively more stable than the absolute counts. This ratio has been reported as a
predictor of clinical outcomes in patients with bacteremia. Also, recent studies reported
that platelet and lymphocytes have a critical role in the inflammatory process.
Given that, this study was designed to assess the role of neutrophil / lymphocyte
ratio and lymphocyte / platelet ratio in diagnosis of EONS.
This observational study was conducted on 100 neonates with EONS who
admitted to NICU of Menoufia university hospital and El-Agoza hospital, during the
period from April 2018 to April 2019, after exclusion of infants with inborn error of
metabolism, congenital anomalies, surgical problems and birth asphyxia and compared
with 100 healthy controls.
Approval of the study was obtained from the Menoufia Faculty of Medicine
Committee for Medical Research Ethics. An informed written consent was taken from
the parents or Caregivers before enrollment in the study.
Neonate with EOS were subjected to complete history taking, clinical
examination, investigations as CBC, CRP and blood culture and assessment of clinical
sepsis score and HSS.
The results of the current study can be summarized as the following:
There was no statistical difference between both groups regarding their sex,
mode of delivery or gestational age. But controls had significantly higher mean
values of weight and length than patients (P= 0.003 and P=0.009, respectively).
Patients had significantly lower mean values of Apgar score at 1 min and at 5
min than controls (p<0.001 for both).
Patients had significantly higher mean values of hospital stay than controls.
Also, there was a significant difference between both groups as regards their
outcome as all controls survived while 42% of patients died.
In this study, maternal history of urinary tract infection (30%: 6%, P<0.001),
fever (9%: 0%, P=0.005), PROM (17%: 4%, P=0.003) and meconium stained
amniotic fluid (14%: 2%, P=0.002) were more prevalent in patients than
controls.
There was a significant higher mean value of clinical sepsis score in patients
(3.86±0.84) than controls (0.10±0.30), in the form of lethargy (p<0.001),
tachycardia (p<0.001), fever (p=0.007), abdominal distension (p<0.001),increase prefeed aspiration (p=0.043), chest retraction (p<0.001) and grunting
(p<0.001).
There were significant higher mean values of TLC, neutrophil and immature
neutrophil in patients than control group (p<0.001, p=0.042 and p<0.001,
respectively). While there were significant lower mean values of lymphocyte,
Hb and platelets count in patients than controls (p<0.001, p=0.001 and p<0.001,
respectively). Also all patients had CRP ≥ 6 while all controls had CRP<6.
There were significant higher mean values of neutrophil/lymphocyte ratio and
lymphocyte/ platelets ratio in patients than controls (p<0.001 for both).
There was a significant higher mean values of HSS (Hematological septic score)
in patients (4.67±1.16) than controls (0.20±0.40), p<0.001.
Out of 100 neonates in patients group 73% had positive bacterial growth, and
was termed the confirmed sepsis group, Klebsiella was the most common (37%),
E coli (34.2%), Staph aureus (19.2%) then Pseudomonas (9.6%)
On comparison between confirmed and suspected sepsis patients, there was no
statistical difference between groups regarding their sex, gestational age, mode
of delivery and weight.
Patients with confirmed sepsis had significantly higher mean values duration of
hospital stay than suspected sepsis patients (p<0.001). Also, as regards their
outcome where, all suspected sepsis patients survived while 57.5% of confirmed
sepsis patients died.
Regarding Apgar score, confirmed sepsis patients had significantly lower mean
values of Apgar score at 1 min and at 5 min than suspected sepsis patients
(p<0.001 and p=0.001, respectively).
There was a significant higher mean value of clinical sepsis score in confirmed
(4.03±0.88) than suspected sepsis patients (3.41±0.50), p=0.001.
In the current study, there were significant lower mean values of Hb, HCT and
platelets count in confirmed than suspected sepsis patients, (p<0.001, p=0.001
and p=0.001, respectively). While there was no statistical difference between
groups regarding TLC, neutrophils of lymphocytes, On the other hand, there
were significant higher mean values of immature neutrophil, p=0.014.
There was no statistical difference between patients with confirmed sepsis and
patients with suspected sepsis regarding Neutrophil /lymphocyte ratio but
significant higher mean values of Lymphocyte/Platelets ratio were found in
confirmed than suspected sepsis patients (p=0.007).
There were significant higher mean values of CRP in confirmed than suspected
sepsis patients (p<0.001).
Regarding HSS, there was a significant higher mean value of HSS in confirmed
(5.11±0.84) than suspected sepsis patients (3.48±1.05), p<0.001. In addition, on
Binary logistic regression analysis for relevant predictors for neonatal sepsis
HSS was a significant predictor for neonatal sepsis among the studied patients.
OR 66.878, 95% CI (3.243-1379.31)
Receiver Operating characteristic Curve (ROC) of clinical sepsis score, HSS,
CRP, neutrophil/lymphocyte ratio and lymphocyte/platelet ratio were done for
predicting early neonatal sepsis. HSS and CRP were good and valid predictors
for early diagnosis of neonatal sepsis (AUC= 0.878 and 0.871, respectively)
while lymphocyte /platelets was a fair predictor (AUC=0.731) but clinical sepsis
score was poor predictor (AUC=0.697) and Neutrophil /Lymphocyte ratio was
in significant.
In this study, the most accurate parameters for diagnosis of early onset neonatal
sepsis was HSS, at cut off value of >2, sensitivity=100%, specificity=22%,
positive predicting value=78%, negative predicting value=100% and
accuracy=79%. While the accuracy of clinical sepsis value was 73%, CRP was
73%, Lymphocyte/platelet ratio was 72% and Neutrophil/lymphocyte ratio was
68%.