Sepscore- An Improved Armament in the Diagnosis of Neonatal Sepsis

Abstract

Introduction: Neonatal sepsis is the third most frequent cause of neonatal mortality. Early diagnosis and treatment are very crucial for successful outcome. Blood culture, which is the gold standard for diagnosis, will not be available early for appropriate management. Haematological Sepsis Scoring (HSS) is a rapid, low-cost sensitive lab tool for diagnosing neonatal sepsis. Modification of HSS (Sepscore) done by removal of repetitive parameters and addition of Neonate Red Blood Cells (nRBC) which are elevated in sepsis, have higher specificity. Aim: To compare the diagnostic utility of the modified HSS (Sepscore) with Rodwell’s HSS. Materials and Methods: The prospective analytical study was conducted over 18 months in a tertiary care hospital in South India blood samples of 350 neonates admitted to Neonatal Intensive Care Unit (NICU) with signs of sepsis were evaluated by HSS and Sepscore. The sensitivity, specificity, predictive values and likelihood ratios of Sepscore and cut-off value of the Sepscore using the Receiver Operating Characteristic (ROC) curve for diagnosis of neonatal sepsis was determined. Results: A total of 146 of 350 (41.7%) had neonatal sepsis and rest served as controls. A total of 188 (53.7%) of our subjects were preterm. The cut-off was determined as three for both HSS and Sepscore. The sensitivity and specificity of HSS were 71% and 54% whereas that of Sepscore was 68% and 61%, respectively. The diagnostic ability of Sepscore was found to be significantly higher than that of HSS (p=0.0094). Conclusion: Sepscore has a higher specificity and marginally lower sensitivity compared to the HSS in neonatal sepsis.