Gastric aspirate cytology as a screening tool for neonatal sepsis: a prospective study from a tertiary care centre

Ranjith Kumar, Bhaskar Reddy, Chapay Soren, Venkataramana Reddy, Raheemunisa .


Background: Neonatal sepsis is a clinical syndrome of bacteremia characterized by systemic signs and symptoms of infection in the first 28 days of life. It is responsible for 30-50% of the total neonatal deaths each year in developing countries. Gastric aspirate cytology has been used for neonatal infection. The presence of more than five polymorphs per high power field co-relate with neonatal infection. The objective of the present study was to evaluate the utility of gastric aspirate cytology as a screening tool for neonatal sepsis and to determine the polymorphonuclear leukocytes count in smear of gastric aspirate and correlating it with culture proven sepsis.

Methods: This prospective observational study was conducted from February 2017 to January 2018 at level III Neonatal intensive care Unit of Sri Venkata Sai Medical College and Hospital, Mahabubnagar, Telangana. A total of 108 neonates with risk factor and / or clinical features of sepsis were included in the study.

Results: Out of 108 neonates, 40 were blood culture positive   and 68 were culture negative. Gastric aspirate smear showed ≥5 polymorphs in 30 and <5 polymorphs in 10 neonates with positive blood culture. Among blood culture negative cases, 20 had ≥5 polymorphs and 48 had <5 polymorphs in gastric aspirate smear. Gastric aspirate culture was positive in 48 neonates and negative in 60 neonates. Of the 48 gastric aspirate positive neonates, 45 had ≥5 polymorphs and 3 had <5 polymorphs in gastric aspirate smear. Similarly, among 60 gastric aspirate culture negative neonates, 55 had ≥5 polymorphs and 3 had <5 polymorphs in gastric aspirate smear. This was statistically significant (P<0.000001). Of 48 neonates with positive gastric aspirate culture, 30 had positive blood culture and 18 had negative blood culture.

Conclusions: Gastric aspirate cytology is a good screening tool for neonatal sepsis added to a detailed perinatal history and clinical examination but does not completely substitute the present day available screening parameters.


Blood culture, Gastric aspirate, Neonatal sepsis

Full Text:



Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2015;385(9966):430-40.

Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: Field trial in rural India. Lancet. 1999;354(9194):1955-61.

National Neonatology Forum NNPD Network. National Neonatal-Perinatal Database: Report for 2002-2003. New Delhi: National Neonatology Forum NNPD Network; 2005.

Camacho-Gonzalez A, Spearman PW, Stoll BJ. Neonatal infectious diseases: evaluation of neonatal sepsis. Pediatr Clin North Am. 2013;60:367-89.

Escobar GJ. What have we learned from observational studies on neonatal sepsis? Pediat Crit Care Med. 2005;6(3):S138-45.

Vasan UN, Lira Dia M, Greenstein RM, Raye JR: Origin of gastric aspirate poly- morphonuclear leucocytes in infants born after prolonged rupture of membranes. J Pediatr.1977;91(1):69-72.

Blanc, W. A. Amniotic infection syndrome: pathogenesis, morphology and significance in circumnatal mortality. Clinical Obstetr Gynecol. 1959; 2(3):705-34.

Chandana A, Rao MN, Srinivas M, Shyamala S. Rapid diagnostic tests in neonatal septicemia. Indian J Pediatr. 1988; 55(6):947-53.

Garland SM, Bowman ED. Reappraisal of C-reactive protein as a screening tool for neonatal sepsis. Pathology. 2003;35(3):240-3.

Leibovich M, Gale R, Slater PE. Usefulness of the gastric aspirate examination in the diagnosis of neonatal infection. Trop Geogr Med. 1987; 39(1):15-7.

Kim SY, Kim JS, Yoon HS. Gastric Aspirate Examination as an Index for Detection of Early Onset Neonatal Sepsis. J Korean Soc Neonatol. 2003; (2):200-7.