Diagnostic Value of Neutrophil to Lymphocyte Ratio on Neonatal Sepsis in Full Term and Preterm Neonates

AL Nady, N.M.; Ismaiel, Y.M.; Assar, E.H.; Saleh, M.H.

doi:10.21608/bjas.2021.214407

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	Diagnostic Value of Neutrophil to Lymphocyte Ratio on Neonatal Sepsis in Full Term and Preterm Neonates
Article 20, Volume 6, Issue 6, December 2021, Page 169-177 PDF (654.34 K)
Document Type: Original Research Papers
DOI: 10.21608/bjas.2021.214407
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Authors
N.M. AL Nady¹; Y.M. Ismaiel²; E.H. Assar¹; M.H. Saleh¹
¹Pediatrics, Dept., Faculty of Medicine, Benha Univ., Benha, Egypt
²Chemical and Clinical Pathology, Dept., Faculty of Medicine, Benha Univ., Benha, Egypt
Abstract
Background: Sepsis is a life-threatening illness with notably high degree of mortality both in preterm and term neonates. Roughly, it may be characterized as a systemic inflammatory response that occurs as a consequence of confirmed or suspected infection in neonatal period. Especially in underdeveloped countries, early detection and treatment of newborns with infections are inadequate. Clinical findings of sepsis in newborns are problematic since many of the symptoms associated to sepsis are unclear and they might be revealed with conditions of other noninfectious disorders. Neonatal sepsis remained a serious concern for neonates across the globe and generates considerable morbidity and death neonates (term and preterm), particularly in underdeveloped nations. It was a clinical illness that defined by systemic infections and characterized by the isolation of bacteria in the blood (bacteremia) that occurs in babies in the first month of life. The cornerstone underlying the development of newborn sepsis is inflammation. Common measures utilized for the effective diagnosis and treatment of newborn sepsis, apart for blood cultures, comprise of inflame inflammatory indicators. Accordingly, the study of inflammatory biomarkers is an essential element of sepsis research. In particular, the influence of inflammation on blood cells such as neutrophils, lymphocytes, and platelets has been a focus of study on the diagnosis of sepsis. The purpose of the study was to establish value of neutrophil to lymphocyte ratio in diagnosis of newborn sepsis in full term and preterm neonates. Methods: This was a prospective research was done at neonatal intensive care unit of Benha university hospital; 120 neonates who were split into 2 groups: Group I (patient) :include 60 septic neonates who were separated into 2 subgroups: Group I (A) : 30 full term newborns and Group I (B) : 30 preterm neonates, whereas Group II (control) :include 60 healthy neonates who were broken into 2 subgroups: Group II (A) : 30 full term newborns and Group II (B) : 30 preterm neonates. Results: In this research, hemorrhage and fever were considerably greater in pre-term septic neonates than full term and pre-term controls. PROM and UTI were considerably greater in full term septic neonates than full term and pre-term controls. In addition, they were substantially greater in pre-term septic neonates than full term and pre-term controls. In the current investigation, the most prevalent organism was Klebsiella (33.3 percent ), followed by E.coli (23.3 percent ), pseudomonas (16.7 percent ), staph aureus (15.0 percent ), Group B streptococcus (6.7 percent ), and strept pneumonia (5.0 percent ). (5.0 percent ). CRP indicated an overall significant difference between research groups (P-value <0.001). Post hoc analysis found that it was considerably higher in full-term septic neonates (24) compared to full-term controls (2.3) and preterm controls (1.8). (1.8). Also, CRP in preterm septic newborns was substantially higher (24) than full-term and preterm controls. In this research, TLC was considerably greater in full-term and preterm septic newborns (18.5 & 17.8, respectively) compared to full-term controls (10.4). (10.4). Our research findings discovered that neutrophils demonstrated that it was considerably greater in full-term septic neonates (11) compared to full-term controls (4.8) and preterm controls (5.8). (5.8). In addition, neutrophils in preterm septic newborns were considerably greater (12) than full-term and preterm controls. In addition, NLR was considerably greater in full-term septic neonates (3.1) compared to full-term and preterm controls (1.3 for each) (1.3 for each). Also, NLR in preterm septic newborns was considerably greater (3.4) than full-term and preterm controls. Our findings indicated that, the lymphocytes count was considerably lower in patients group compared to controls group. In full term our research septic group, NLR exhibited a significant negative connection with Apgar 1 minute (r = -0.512 & P-value = 0.004). In contrast, it exhibited a significant positive connection with CRP (r = 0.362 & P-value = 0.05). While, in pre-term septic group, NLR exhibited a significant negative connection with Apgar 1 minute (r = -0.570 & P-value = 0.001), Apgar 5 minutes (r = -0.384 & P-value = 0.036), and platelets (r = -0.373 & P-value = 0.042). In this study, NLR higher than 1.6698 showed an excellent AUC with sensitivity and specificity were 90 percent and 91.7, respectively in diagnosing neonatal sepsis and had sensitivity and specificity were 100 percent and 86.7 percent , respectively in diagnosing neonatal sepsis in preterm neonates. While, NLR more than 1.5135 demonstrated a good AUC with sensitivity and specificity were 96.7 percent and 90 percent , respectively in detecting neonatal sepsis in full-term neonates. Conclusion: From our research we concluded that we give evidence that NLR may be employed in addition to standard indicators such as CRP in the diagnosis and subsequent therapy of newborn sepsis. In addition, NLR is affordable and widely accessible instrument in contrast to other comparatively more costly technologies.
Keywords
Neutrophil; Lymphocyte; Neonatal Sepsis; Full Term Neonates; Preterm Neonates


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