HEMATOLOGIC SCORING SYSTEM IN EARLY DIAGNOSIS OF SEPSIS IN NEUTROPENIC NEWBORNS

The hematologic profiles of 1000 newborns were prospectively examined to identify infants with neutropenia (N = 170) according to the system of Manroe et al. (J Pediatr 1979;95:89-98) and to evaluate a hematolo gic scoring system (Rodwell et al. J Pediatr 1988; 112:761-7) as a scr eening test for sepsis. Neutropenia was more commonly of noninfectious than infectious origin (83.5% vs. 16.5%; P < 0.001). On the initial t est a positive screen (scores greater-than-or-equal-to 3) identified 2 6 of 28 infants with sepsis or probable infection (sensitivity 93%; sp ecificity 82%; positive and negative predictive values 50 and 98%, res pectively). Corresponding values for an elevated immature:total neutro phil ratio were 100, 75, 43 and 100%. Overall mortality with neutropen ia was 15% and was higher with an infectious than a noninfectious etio logy (39% vs. 11%, P < 0.001) despite early antibiotic therapy. The co mbination of a neutrophil count less-than-or-equal-to 500/mm3 and scor es greater-than-or-equal-to 3 or an elevated immature: total neutrophi l ratio identified a poor prognostic group: 67% (8 of 12) and 70% (7 o f 10) infants, respectively, with these findings died, 6 in the infect ed group. The hematologic scoring system or immature:total neutrophil ratio in combination with the degree of neutropenia provides valuable diagnostic and prognostic information which could be applied to identi fication of possible candidates for granulocyte transfusions or other experimental treatments.