Diagnostic utility of Haematological scoring system (HSS) with clinicopathological and bacteriological evaluationin early diagnosis of neonatal sepsis

  • Bhagyashree M Ahirrao Department of Pathology, ACPM Medical college Morane, Dhule, Maharashtra, India
  • Nandkumar Dravid
  • Mahesh Ahirrao
  • Dhiraj Nikumbh
  • Arundhati Gadre
  • Shirish Gondane
Keywords: Haematological scoring system, Neonatal sepsis, peripheral blood smears


Background: Neonatal sepsis is a major cause of mortality with high incidence of 11 to 24.5 per 1000 live births in India.  Delay in diagnosis further  increases the mortality to 30-40% of  total neonatal deaths. Though blood culture is gold standard for diagnosis of neonatal sepsis, it has limitations.  The comprehensive Hematologic scoring system (HSS) formulated by Rodwell et al is used for early diagnosis  of sepsis. This comprises of Immature/Total neutrophil ratio, Total PMN count, Immature/Mature  ratio, Immature PMN count, degenerative changes in  PMN, platelet count.Methods: This is a prospective study of haematologic profiles of 333 neonates admitted in neonatal care unit in our institute. Field stained blood  smears were examined for HSS. Blood culture was done before administration of antibiotic treatment. Neonates with predisposing perinatal risk factors or if there was clinical suspicion of sepsis were included in this study from Nov 2014 to feb 2016. Result: Of the 303 neonates in the present study, 77 had positive blood cultures, The incidence of septicemia was higher in males (72.7%) than females (27.3%). Majority of the neonates presented with early onset type of sepsis (91%). Elevated I: T ratio and I:M ratio were seen in most cases of septicemia.  Conclusion: HSS is the most sensitive indicator of sepsis. Use of HSS by peripheral smear study Blood culture can be used effectively as a sepsis screen for early diagnosis is useful to reduce neonatal morbidity and mortality.DOI: 10.21276/APALM.1504 

Author Biography

Bhagyashree M Ahirrao, Department of Pathology, ACPM Medical college Morane, Dhule, Maharashtra, India
Department of PathologyAssistant  professor


1.National Neonatal Perinatal Database 2002-2003 report. http://www.nnfi.org/images/NNPD2002-03.pdf. (Last accessed on Jan 22, 2016).

2.Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of neonatal sepsis using a Haematologic Scoring System. J Pediatr 1988;112:761-767.

3.Manroe BL, Weinberg AG, Rosenfeld CR, Browne R. The neonatal blood count in health and disease. Reference values for neutrophilic cells. J Pediatr 1979;95(1):89-98.

4. Shankar MJ, Agrawal R, Deorari AK, Paul V. Sepsis in newborn. AIIMSNICU protocols 2008:1-18.

5. Chandna A, Rao MN, Srinivas M, Shyamala S. Rapid Diagnostic Tests in Neonatal Septicemia. Indian J Pediatr 1988;55:947-953.

6. Ghosh S, Mittal M, Jaganathan G. Early diagnosis of neonatal sepsis using a hematological scoring system. Indian J Med Sci 2001;55:495-500.

7. Makkar M, Gupta C, Pathak R, Garg S, Mahajan NC. Performance of evaluation of hematological scoring system in early onset neonatal sepsis. Journal of Clinical Neonatology 2013 Jan-Mar;2(1):25-29.

8. Supreetha MS et al. Evaluation of Neonatal septicemia using Haematological parameters. International Journal of Recent and Scientific Research vol 6,Issue 2,pp 2775-2778,Feb 2015.

9. Narasimha A, Harendrakumar ML. Significance of hematological scoringsystem (HSS) in early diagnosis of neonatal sepsis. Indian J Hematol Blood Transfus 2011;27(1):14-17.

10. Gheibi S, Fakoor Z, Karamyyar M, Khashabi J, Ilkhanizadeh B, Sana FA, et al. Coagulase negative staphylococcus; most common causes of neonatal septicemia in Urmia, Iran. Iran J Pediatr 2008 Sept;18(3):237-243.

11.Khair KB, Rahman MA, Sultana T, Roy CK, Rahman MQ, Shahidullah M et al. Role of hematological scoring system in early diagnoses of neonatal septicemia. BSMMU J 2010;3(2):62-67
Original Article