Diagnostic Values of Complete Blood Count Parameters and C-Reactive Protein in Neonatal Sepsis Workup

Abstract

Background: Neonatal sepsis is a critical global health issue with high morbidity and mortality rates. Despite ongoing advances in maternal and neonatal care, due to antibiotic resistance, culture-negative cases, and non-specific symptoms, the accurate diagnosis of neonatal sepsis remains challenging. Objectives: This study aims to investigate the diagnostic values of complete blood count (CBC) parameters and C-reactive protein (CRP) as available and cost-effective biomarkers of neonatal sepsis. Methods: In this diagnostic test accuracy study conducted from April 2020 to September 2022, we evaluated the diagnostic values of CBC parameters and CRP for neonatal sepsis among 277 newborns admitted to 17 Shahrivar Hospital. Neonates diagnosed with sepsis were categorized based on sterile body fluid culture results, clinical manifestations, and the age of sepsis onset. Various characteristics (including gender and age of neonates, maternal age, gestational age, neonatal weight, birth weight, Apgar score, and mode of delivery) were considered for the study as potential risk factors for neonatal sepsis. Additionally, we reviewed related studies and compared their findings with ours for a more comprehensive conclusion. Results: Our study revealed that red cell distribution width (RDW) was significantly higher in probable (16.59 ± 1.92) and proven septic groups (16.43 ± 1.67) than the non-septic (or control) group (13.37 ± 1.19; P = 0.001). Among other CBC parameters, lower white blood cell (WBC) value in the proven sepsis group was borderline significant (P = 0.05), while absolute neutrophil count (ANC) and platelet count showed no statistically significant difference among cases and controls (P = 0.273 and P = 0.467, respectively). In addition, positive qualitative plasma CRP had a significant relationship with the diagnosis of neonatal sepsis (P < 0.001). Among considered demographic characteristics of the neonates, significant intergroup differences were detected regarding neonatal age (P < 0.001), gestational age (P = 0.008), and mean quantitative maternal age (P = 0.037) for neonatal sepsis. At an optimal cutoff level of 14.1%, RDW had a sensitivity of 91.98% and a specificity of 82.22% for identifying neonates with probable and proven sepsis in this study. Conclusions: Available and cost-effective biomarkers, such as elevated RDW level (as the most efficient CBC parameter) and positive CRP, can play an important role in the timely diagnosis of neonatal sepsis.