Abstract

Background Neonatal sepsis, a significant cause of morbidity and mortality, is a systemic response to infection in the first month of life. Its early diagnosis is challenging due to nonspecific clinical manifestations and the time-intensive nature of blood cultures, the diagnostic gold standard. The Hematological Sepsis Scoring (HSS) system, introduced in 1988, offers a rapid diagnostic alternative using hematological parameters. To enhance diagnostic accuracy, the Modified HSS incorporates additional parameters, such as nucleated RBC, and assigns higher weightage to neutropenia. This study evaluates the utility of the Modified HSS in the early diagnosis of neonatal sepsis, aiming to facilitate prompt treatment and reduce neonatal mortality.

Methods This descriptive analytical study was conducted over a year at B.P. Koirala Institute of Health Sciences, involving neonates >34 weeks of gestation within four weeks of birth, clinically suspected of sepsis. Blood samples were analyzed using Modified Hematological Sepsis Scoring (HSS) and BacT/ALERT for culture. Purposive sampling selected 147 cases. Ethical clearance was obtained, and informed consent secured. Hematological parameters, including TLC, ANC, IT ratio, and nucleated RBC, were assessed, and cultures were processed for microbial identification and susceptibility.

Results The study included 147 neonates with suspected sepsis (male:female ratio 1.33). Blood cultures were positive in 21 cases, with early-onset sepsis predominant (81%). Modified Hematological Sepsis Scoring (HSS) showed high diagnostic accuracy: sensitivity (90.48%), specificity (96.83%), and accuracy (95.91%) for HSS ≥4. Among hematological parameters, degenerative changes had the highest sensitivity (95.23%), and nucleated RBC showed the highest accuracy (91.15%). Staphylococcus aureus (52.3%) was the most common pathogen. Modified HSS proved effective for early sepsis diagnosis.

Conclusion Modified HSS is an effective and accurate tool for early neonatal sepsis diagnosis, with high sensitivity, especially when using a score ≥4 as the cutoff. The inclusion of nucleated RBC enhances sensitivity, while the system’s diagnostic accuracy is improved by recalibrating parameters. Modified HSS, utilizing common hematological parameters, shows significant potential for clinical application.

Competing Interest Statement

The authors have declared no competing interest.

Clinical Protocols

N/Apa

Funding Statement

The author(s) received no specific funding for this work.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical clearance was obtained from Institutional Ethical Review Board, (Ref no. 487/079/080-IRC, code number IRC/2319/022). Written informed consent was obtained from the parents or legal guardians of all neonatal participants before their inclusion in the study. The consent process included a detailed explanation of the study’s purpose, procedures, potential risks, and benefits. For illiterate guardians, the consent form was read aloud in the presence of an independent witness, who confirmed their voluntary participation with a signature. The study was approved by the Institutional Review Committee (IRC) and all procedures adhered to ethical guidelines.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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Data Availability

All relevant data are within the manuscript and its Supporting Information files.

LIST OF ABBREVIATIONSANCAbsolute Neutrophil CountAPCAntigen Presenting CellAPRAcute Phase ReactantCBCComplete Blood CountCRPC-Reactive ProteinDAMPsDamage Associated Molecular PatternsDCDendritic CellsDLCDifferential Leucocyte CountEOSEarly Onset SepsisGBSGroup B StreptococcusG-CSFGranulocyte Colony Stimulating FactorGM-CSFGranulocyte Monocyte Colony Stimulating FactorHSSHematological Scoring SystemI:TImmature: TotalICUIntensive Care UnitIFN-γInterferon γILInterleukinLBPLipopolysaccharide binding proteinLOSLate Onset SepsisMBLMannan-binding lectinMSAFMeconium Stained Amniotic FluidNODNucleotide Binding Oligomerization DomainNPVNegative Predictive ValuePAMPsPathogen Associated Molecular PatternsPPVPositive Predictive ValuePMNPolymorphonuclearPROMPremature Rupture of MembranePRRPathogen Recognition ReceptorRIGIRetinoic –acid-induible-proteinSAASerum Amyloid ATLCTotal Leucocyte CountTLRsToll like ReceptorsTNF-αTumour Necrosis Factor α