What is it about?
"Suspected sepsis" is one of the most frequently encountered diagnosis in neonatology because a) a large number of newborns are evaluated for sepsis - early or late sepsis - based on risk factors and for fear of missing a correct diagnosis and a prompt treatment (8); b) in neonates, the clinical signs of infection are not specific, late, and the differential diagnosis with neonatal respiratory distress syndrome, aspiration syndromes, or neonatal maladaptation to extrauterine life is difficult (8-10); c) blood culture - the golden standard in neonatal sepsis diagnosis - offers late information, has a poor accuracy, and is not universally available (11); and d) still we don't have an ideal diagnostic tool for neonatal infection (12). Therefore, diagnosis of neonatal sepsis is still a challenge for neonatal medicine. Antibiotic therapy is often initiated based on clinical suspicion and/or the presence of the risk factors, leading to excessive antibiotic therapy. Very often, the diagnosis of neonatal sepsis is representing documentation of an infection in a newborn with severe systemic disease in which all non-infectious etiology possible in that altered pathophysiological status were excluded (13).
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Why is it important?
The "gold standard", definitive test for neonatal sepsis is the isolation of the pathogen from blood (9). But multiple factors are influencing its accuracy: a) contamination during sampling; b) sampling after antibiotic therapy was started; c) insufficient volume sampling; d) low colony count bacteriemia (14). In various studies, the accuracy of blood culture varies between 8 and 73% (6,11,15).
Perspectives
For many years now, CBC, with its limits and biases, continues to be the most frequently used and useful screening test for neonatal EOS (11), only recently CRP being added in order to increase the predictive accuracy (9). Tests with better predictive accuracy - such as procalcitonin, cytokines, etc. - are not universally available and expensive. Still, none of the actual markers of infection is sufficiently sensitive or specific to definitely influence the decision to start antibiotic therapy independent of the clinical signs and most of the tests used to diagnose infection are more useful for identification of the neonates without infection (17). Therefore we, the clinicians, are obliged to have a pragmatic approach as regards the use of the available tests for neonatal EOS diagnosis and antibiotic therapy guidance. Interpretation of the screening tests used for early diagnosis of EOS must be done in accordance with the risk factors and clinical signs and symptoms suggesting infection. Presence of the clinical signs or symptoms suggesting infection should prompt antibiotic therapy even if the screening tests are negative (22). Hopefully, a better understanding of the inflammatory response in preterm and term neonates may lead to improved screening for neonatal sepsis.
Assoc. Prof., MD, PhD Maria Livia Ognean
Clinical County Emergency Hospital Sibiu; Faculty of Medicine, University Lucian Blaga Sibiu
Read the Original
This page is a summary of: Complete blood count and differential in diagnosis of early onset neonatal sepsis, Revista Romana de Medicina de Laborator, January 2017, De Gruyter,
DOI: 10.1515/rrlm-2016-0042.
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