Utility of Hematological Scoring System in Diagnosis of Neonatal Sepsis

  • Aparna S SRRI, Trivandrum, India
  • Vivek George SGMC, Trivandrum, India
  • Limi Mohandas SGMC, Trivandrum, India
  • Lisha S Raj KIMS, Trivandrum India
  • Sheela Vasudevan SGMC, Trivandrum, India
Keywords: Blood culture, WBC count, Early onset sepsis (EOS), I/T ratio


Background: Neonatal septicemia is defined as a clinical syndrome characterized by systemic signs and symptoms caused by a bacterial infection and gives positive blood culture in the first month of life. It is associated with high morbidity and mortality, but early diagnosis and treatment significantly improve the outcomes. The present study brings out a quick and cost- effective Hematological Scoring System that enables early diagnosis of neonatal sepsis Method: This study was conducted in the Department of Pathology of Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Thiruvananthapuram over 1 year. Eighty neonates with clinical suspicion of sepsis were studied with respect to their peripheral smear findings, blood culture and C-reactive protein levels. Result: Among the eighty cases, twelve neonates were culture positive. Male gender and late- onset of sepsis were the significant risk parameters. Escherichia coli and Staphylococcus aureus were the most common isolated organisms. Of the different parameters studied I:T ratio and Absolute neutrophil count showed the highest specificity and immature neutrophil count had the highest sensitivity. Forty-one percent of neonates had a high Hematological Scoring System score. The specificity of Hematological Scoring System with a score > 5 was 92% Conclusion: Hematological Scoring System is a cost-effective, rapid and easy to perform screening test that can be used to rule out sepsis thus avoiding unnecessary administration of antibiotics to unaffected babies. It should be adopted as a routine screening procedure by minimally qualified rural doctors with minimal resources to ensure appropriate action immediately for children with high index of suspicion of sepsis. 


1. Sriram R. Correlation of blood culture results with the sepsis score and sepsis screen in the diagnosis of neonatal sepsis. Int J Biol Med Res 2011; 2(1):360-8.
2. Varsha, Rusia U,Sikka M, Faridi MM, Madan N. Validity of haematological parameters in identification of early and late onset neonatal infection. Indian J Pathol Microbiol 2003; 46(4): 565-8.
3. MS Supreetha, Alva Sathyavathi. Evaluation of neonatal septicemia using hematological parantelers. International Journal of Recent Scientific Research 2015; 6(2):2775-2778.
4. Zaki Mel-S, el-Sayed H.Evaluation of microbiologic and hematologic parameters and E-selectin as early predictors for outcome of neonatal sepsis.Arch Pathol Lab Med. 2009; 133(8):1291-6.
5. Claus Klingenberg, Rene F Kornelisse. Culture Negative Early Onset Neonatal sepsis-At the crossroad between efficient sepsis care and antimicrobial stewardship. Frontiers in Pediatrics.2018;6:285.
6. Shirazi Haider, Sadia Riaz, Tahir Rida. Role of haematological profile in early diagnosis of neonatal sepsis. Ann Pak Inst Med Sci 2010; 6(3):152-6.
7. Mihir J Bhalodia, Surekha B Hippargi. Role of hematological scoring system in diagnosis of neonatal sepsis. Journal of Clinical Neonatology 2017;6(3):144-147.
8. Rodwell RL, Lesile AL, Tudehope DI. Early diagnosis of neonatal sepsis using a haematological scoring system. J Pediatr 1988; 112(5):761-7.
9. Alonso Zea-Vera, Theresa J Ochoa. Challenges in the diagnosis and management of neonatal sepsis. Journal of Tropical Pediatrics.2015;61(1):1-13.
10. Buch AC, Srivastava V, Kumar H, Jadhav PS. Evaluation of haematological profile in early diagnosis of clinically suspected cases of neonatal sepsis.Int J Basic and applied sciences 2011; 1(1):1-6.
11. Nandy M, Dutta S, Ganguly S, et al. Changing Spectrum of Neonatal Septicemia. The Child and Newborn.2007;11:1
12. DE A, Saraswati DE A, Saraswati K,Gogate A, Raghavan K. C-Reactive protein and buffy coat smear in early diagnosis of childhood septicemia. Indian J Pathol Microbiol1998; 41(1)23-6.
13. Khair K B, Rahman M A, Sultana T,et al. Role of Hematologic Scoring System in Early Diagnosis of Neonatal Septicemia. BSMMU J .2010; 3(2): 62-67.
14. Narasimha A, Harend Narasimha A, Harendra kumar M.L. Significance of hematological scoring system(HSS) in early diagnosis of neonatal sepsis. Indian J Hematol Blood Transfus. 2011; 27(1):14-7.
15. Makkar M, Gupta C, Pathak R, Garg S, et al. Performance evaluation of haematological scoring system in early diagnosis of neonatal sepsis. J Clin Neonatol 2013; 2(1):25-9.
16. Saleem M,Shan Israr K.Hematolgical scoring system for early diagnosis of neonatal sepsis.Journal of Rawalpindi Medical College 2014;18(1):68-72.
17. Ghosh S, Mittal M. Early Diagnosis of Neonatal Sepsis using a Hematological System.Ind J Med Sci 2001;55(9):495-500
Original Article