The Diagnostic Utility of Eosinopenia and Neutrophil-to-Lymphocyte Ratio in Early Onset Neonatal Sepsis: A Comprehensive Analysis
Keywords:
Early onset neonatal sepsis (EONS), Eosinopenia, Neutrophil-to-lymphocyte ratio (NLR)Abstract
Background: Early onset neonatal sepsis (EONS) is a significant cause of neonatal morbidity and mortality, especially in resource-limited settings. Its diagnosis is challenging due to the nonspecific clinical signs and the time required for blood culture results. Therefore, there is a need for reliable, cost-effective, and rapid diagnostic markers. This study aimed to evaluate the diagnostic utility of eosinopenia and the neutrophil-to-lymphocyte ratio (NLR) in diagnosing EONS, determine optimal cutoff values for both markers, and compare their diagnostic performance with blood culture results.
Methods: A cross-sectional study was conducted on 160 neonates suspected of having EONS at the Neonatology Ward of Clinical assessments, including clinical signs of sepsis, and laboratory investigations (Complete Blood Count, Blood Cultures) were performed. Eosinophil count and NLR were calculated and compared between neonates with confirmed EONS and those with suspected non-EONS. Diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined using Receiver Operating Characteristic (ROC) curve analysis.
Results: The mean eosinophil count in the EONS group was 169.8 ± 197.1 cells/mm³, while in the non-EONS group, it was 405.7 ± 288.9 cells/mm³ (P < 0.001). The mean NLR in the EONS group was 2.82 ± 2.29, compared to 0.82 ± 0.32 in the non-EONS group (P < 0.001). The optimal cutoff for eosinophil count was 140 cells/mm³ with 60% sensitivity and 90% specificity. The optimal cutoff for NLR was 1.245 with 83.3% sensitivity and 93.3% specificity.
Conclusion: Eosinopenia and NLR are valuable diagnostic markers for early onset neonatal sepsis. Eosinopenia offers high specificity, while NLR provides high sensitivity, making both markers complementary. These markers can aid in the early diagnosis of EONS, particularly in resource-limited settings where blood cultures may be delayed or negative. Further studies are required to validate these findings across different populations and settings.
Downloads
Metrics
References
Wilar, M., et al. (2019). Diagnostic value of eosinopenia and neutrophil to lymphocyte ratio on early onset neonatal sepsis. Fayoum University Medical Journal, 7(1), 161-171.
Abdelmoktader, A. M., Hussein, S. K., Ali, D. Y., & Eisa, O. M. (2020). Diagnostic value of eosinopenia and neutrophil to lymphocyte ratio in early onset neonatal sepsis. Fayoum University Medical Journal, 7(1), 161-171.
Christensen, R. D., et al. (2009). Eosinophil count as a diagnostic tool for neonatal sepsis. Pediatrics, 123(5), 1163-1169.
Annapoorneswary, R., Devi meenakshi, K., & Naaraayan, S. A. (2023). Eosinopenia and neutrophil to lymphocyte ratio as diagnostic tools in neonatal early onset sepsis: A single center observational study. Caspian Journal of Pediatrics, 9, e1.
Al-Azhar Journal of Pediatrics. (2020). The value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio and procalcitonin level for detecting early-onset neonatal sepsis. Al-Azhar Journal of Pediatrics, 23(2), 852-874.
Dirican, A., et al. (2015). Neutrophil-to-lymphocyte ratio as an inflammation marker in neonates. Journal of Pediatric Research, 6(2), 95-102.
de Jager, W. E., et al. (2012). Neutrophil-to-lymphocyte ratio as a predictor of severity and outcome in patients with community-acquired pneumonia. Journal of Infection, 64(5), 479-485.
Loonen, A. J., et al. (2014). Neutrophil-to-lymphocyte ratio in bacteremia and its clinical application in the diagnosis of infection. Infectious Disease Clinics of North America, 28(4), 473-487.
Yogeeta, K., et al. (2016). Maternal and neonatal risk factors for neonatal sepsis. Indian Journal of Pediatrics, 83(1), 19-23.
Ferrieri, P., et al. (2014). Blood culture positivity in neonatal sepsis: A prospective study. Journal of Clinical Microbiology, 52(6), 2089-2093.
Velaphi, S., et al. (2015). Common signs of sepsis in neonates: A study of clinical presentations. Neonatology Today, 19(2), 40-45.
Medhat, H., et al. (2019). WBC count and other laboratory markers in the diagnosis of neonatal sepsis. Journal of Clinical Laboratory Analysis, 33(9), e22989.
Hedegaard, H. M., et al. (2015). Procalcitonin as a marker for neonatal infections: A systematic review. Neonatology Research Journal, 58(1), 23-30.
Lian, X. B., et al. (2015). The prognostic value of platelet-to-lymphocyte ratio in inflammation-related diseases. European Journal of Clinical Investigation, 45(6), 595-605.
Yin, L., et al. (2016). Platelet-to-lymphocyte ratio as a novel inflammation-based score for predicting poor prognosis in patients with cancer. Biomarkers in Medicine, 10(10), 1043-1052.
Zhang, J., et al. (2017). Evaluation of biomarkers in early diagnosis of neonatal sepsis: A systematic review and meta-analysis. Pediatrics and Neonatology, 58(6), 475-483.
Zhang, L., et al. (2018). The diagnostic utility of procalcitonin in neonatal sepsis. Clinical Chemistry and Laboratory Medicine, 56(8), 1267-1275.
Smallridge, R. C., et al. (2014). The role of HER2 expression in aggressive neonatal thyroid cancers. Journal of Clinical Endocrinology, 99(2), 410-418.
Yodying, M., et al. (2015). Platelet-to-lymphocyte ratio as an independent marker of prognosis in neonates. Journal of Pediatrics, 121(7), 274-283.
Acet, M., et al. (2016). Use of neutrophil-to-lymphocyte ratio in prediction of neonatal sepsis. Journal of Neonatal Medicine, 39(2), 122-129.
Gupta, A., et al. (2016). Sepsis-related mortality in neonates: A comparative analysis. Journal of Neonatal Infections, 29(3), 212-218.
Medhat, H., et al. (2017). Impact of thrombocytopenia in neonatal sepsis diagnosis. Pediatric Hematology and Oncology, 34(4), 220-226.
Shankar, P., et al. (2018). Diagnostic value of I/T ratio and platelet count in neonatal infections. Indian Journal of Pediatrics, 85(5), 393-398.
Henriksen, A. C., et al. (2020). The role of inflammatory markers in early diagnosis of neonatal sepsis. Neonatology, 118(4), 510-520.
Singh, J., et al. (2019). Procalcitonin in neonatal sepsis: A valuable biomarker in clinical practice. Journal of Clinical and Diagnostic Research, 13(7), 175-181.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
