Modified hematological sepsis score in early diagnosis of neonatal sepsis

Vani Krishnamurthy, Deepti Thandaveshwar, Srinivasa Murthy Doreswamy


Background: Diagnosis of neonatal sepsis at an early stage substantially reduces the mortality. The clinician often relies on laboratory parameters to support the clinical suspicion. As blood culture takes time and yield is low, hematological and biochemical parameters often guide to the diagnosis and management. Rodwell’s Hematological sepsis score (HSS) has a reasonable sensitivity but low specificity. Some of the parameters included in that scoring system are repetitive of same pathogenic mechanism. A modified HSS was developed by the authors by removing the repetitive parameters, increasing the weightage for low neutrophil count and adding a new parameter - nucleated RBC. Objective of the study was to compare the diagnostic ability of the modified hematological sepsis score with Rodwell’s hematological sepsis score.

Methods: Prospective analytical study conducted in a tertiary level hospital. Neonates admitted to NICU and had complete blood count done were included. Babies with clinical signs of systemic inflammatory response syndrome and evidence of organ dysfunction were considered septic. They were classified as proven sepsis if the blood culture was positive. All the samples were scored for both HSS and modified HSS. The sensitivity, specificity and other diagnostic ability tests were compared between the two scoring systems.

Results: Total of 75 neonates were enrolled. 25 of them had sepsis and three had blood culture positive. At a score of 3, the sensitivity and specificity of HSS was 80 and 70% and that of Modified HSS was 84 and 82% respectively.

Conclusions: Modified hematological score improves the specificity and likelihood ratios without decreasing the sensitivity in early diagnosis of neonatal sepsis.


Hematological sepsis score, Modified hematological sepsis score, Neonate, Sepsis

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Connell TG, Rele M, Cowley D, Buttery JP, Curtis N. How reliable is a negative blood culture result? Volume of blood submitted for culture in routine practice in a children’s hospital. Pediatr. 2007;119(5):891-6.

Ghosh S, Mittal M, Jaganathan G. Early diagnosis of neonatal sepsis using a hematological scoring system. Indian J Med Sci. 2001;55(9):495.

Mannan M, Shahidullah M, Noor MK, Islam F, Alo D, Begum N. Utility of C-reactive protein and hematological parameters in the detection of neonatal sepsis. Mymensingh Med J. 2010;19(2):259-63.

Mondal SK, Nag DR, Bandyopadhyay R, Chakraborty D, Sinha SK. Neonatal sepsis: role of a battery of immuno hematological tests in early diagnosis. Int J Appl basic Med Res. 2012;2(1):43-7.

Narasimha A, Harendra Kumar ML. Significance of hematological scoring system (HSS) in early diagnosis of neonatal sepsis. Indian J Hematol Blood Transfus. 2011;27(1):14-7.

Rodwell, Leslie, Tudehope. Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr. 1988;112(5):761-7.

Makkar M, Gupta C, Pathak R, Garg S, Mahajan NC. Performance evaluation of hematologic scoring system in early diagnosis of neonatal sepsis. J Clin Neonatol. 2013;2(1):25-9.

Manucha V, Rusia U. Utility of haematological parameters and C‐reactive protein in the detection of neonatal sepsis. Paediatr. 2002;38(5):459-64.

Pramana KP, Kardana IM, Nilawati GA. Diagnosis Accuracy of hematological scoring system in early identification of neonatal sepsis. Bali Med J. 2016;5(3):139-44.

Baschat AA, Gungor S, Kush ML, Berg C, Gembruch U, Harman CR. Nucleated red blood cell counts in the first week of life: a critical appraisal of relationships with perinatal outcome in preterm growth-restricted neonates. Am J Obstet Gynecol. 2007;197(3):2-3.

Dulay AT, Buhimschi IA, Zhao G, Luo G, Abdel-Razeq S. Basic science: obstetrics nucleated red blood cells are a direct response to mediators of inflammation in new-borns with early onset neonatal sepsis. Am J Obstet Gynecol. 2008;198(4):426.e1-9.

Romero R, Savasan ZA, Chaiworapongsa T, Berry SM, Kusanovic JP, Hassan SS, et al. Hematologic profile of the fetus with systemic inflammatory response syndrome. J Perinat Med. 2012;40(1):19-32

Hornik CP, Benjamin DK, Becker KC, Benjamin DK, Li J, Clark RH, et al. Use of the complete blood cell count in late-onset neonatal sepsis. Pediatr Infect Dis J. 2012;31(8):803-7.

Mikhael M, Brown LS, Rosenfeld CR. Serial neutrophil values facilitate predicting the absence of neonatal early-onset sepsis. J Pediatr. 2014;164(3):2013-4.

Bang AT, Bang RA, Bactule SB, Reddy HM, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet. 1999;354:1955-61.

Afsharpaiman S, Torkaman M, Saburi A, Farzaampur A, Amirsalari S, Kavehmanesh Z. Trends in incidence of neonatal sepsis and antibiotic susceptibility of causative agents in two neonatal intensive care units in Tehran, I.R Iran. J Clin Neonatol. 2012;1(3):124-30.

Dutta S, Narang A, Chakraborty A, Ray P. Diagnosis of neonatal sepsis using universal primer polymerase chain reaction before and after starting antibiotic drug therapy. Arch Pediatr Adolesc Med. 2009;163(1):6-11.

Sharma D, Farahbakhsh N, Shastri S, Sharma P. Biomarkers for diagnosis of neonatal sepsis: a literature review. J Matern Fetal Neonatal Med. 2017;7:1-14.