Neutrophil to lymphocyte ratio as a marker of neonatal sepsis in resource limited settings

Hrishikesh S. Pai

doi:10.18203/2349-3291.ijcp20222764

Authors

Hrishikesh S. Pai Department of Pediatrics and Neonatology, Lourdes Hospital Cochin, Kochi, Kerala, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20222764

Keywords:

Neonatal, Sepsis, NLR, Term

Abstract

Background: Neonatal period forms basic foundation which influences the future health of a child. It is often complicated by neonatal sepsis. In resource limited settings especially in rural and tribal areas with limited laboratory services it will be not possible to have all investigations. Study aims to determine utility of simple neutrophil to lymphocyte ratio as a marker of sepsis in neonates within the first week of life.

Methods: Retrospective descriptive study in a tertiary care hospital in Kochi. Objective of this study was to analyse neutrophil to lymphocyte ratio in babies with sepsis to that of babies without sepsis. Data of 300 babies were collected which included 150 babies with sepsis and 150 babies with no sepsis. Records showing complete history, clinical diagnosis, appropriate investigation and management details of term babies within 7 days of life were included. Preterm babies, Babies with congenital malformations, outborn babies, babies with incomplete records were excluded.

Results: In this study, mean value of neutrophil to lymphocyte ratio in babies with sepsis were 3.73 compared to 1.22 in babies with no sepsis. For babies with sepsis±1SD values were 5.21 and 2.25 respectively and for babies with no sepsis were 1.74 and 0.70. For babies with sepsis±2 SD values 0.77 and 6.69 respectively and 0.18 and 2.26 for babies with no sepsis.

Conclusions: Mean values of NLR values were significantly higher in those with sepsis than in those without sepsis NLR ratio is higher in cases with sepsis (3.728±1.483) compared to the cases with no sepsis (1.217±0.521). A value more than 2.25 can be indicator of sepsis.

Metrics

Metrics Loading ...

Author Biography

Hrishikesh S. Pai, Department of Pediatrics and Neonatology, Lourdes Hospital Cochin, Kochi, Kerala, India

Department of pediatrics and neonatology,Consultant pediatrician

References

Agarwal R, Deorari A, Paul V, Sankar J, Sachdeva A. AIIMS Protocols in Neonatology. 2nd ed. New Delhi: Noble Vision; 2019.

Borges J, Ventura A, Costa P, Abrantes M, Graça A. Early neonatal sepsis screening: procalcitonin and c-reactive protein diagnostic value. J Neonatol Clin Pediatr. 2020;7:54.

Sumitro KR, Utomo MT, Widodo ADW. Neutrophil-to-lymphocyte ratio as an alternative marker of neonatal sepsis in developing countries. Oman Med J. 2021;36(1):e214.

Omran A, Maaroof A, Mohammad MHS, Abdelwahab A. Salivary C-reactive protein, mean platelet volume and neutrophil lymphocyte ratio as diagnostic markers for neonatal sepsis. J Pediatr (Rio J). 2018;94(1):82-7.

Li T, Dong G, Zhang M, Xu Z, Hu Y, Xie B, et al. Association of neutrophil–lymphocyte ratio and the presence of neonatal sepsis. J Immunol Res. 2020;3: 2020.

Wilar R. Diagnostic value of eosinopenia and neutrophil to lymphocyte ratio on early onset neonatal sepsis. Korean J Pediatr. 2019;62(6):217-23.

Dong G, Zhang M. The value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio and procalcitonin level for detecting early-onset neonatal sepsis. Al-Azhar J Pediatr. 2020;23(2):852-74.

Panda SK, Nayak MK, Rath S, Das P. The utility of the neutrophil-lymphocyte ratio as an early diagnostic marker in neonatal sepsis. Cureus. 2021; 13(1):23-8.

Jin JH. Neonatal sepsis. Pediatr Ther. 2018;8:73-8.

Mahmoud NM, Abdelhakeem M, Mohamed HH, Baheeg G. Validity of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in diagnosing early-onset neonatal sepsis in full-term newborns. J Comprehens Pediatr. 2022;13(1):23-9.

Lim H, Sukmawati M, Artana WD, Kardana M, Putra PJ. Validity of Neutrophil Lymphocyte Count Ratio in Neonatal Sepsis. Int J Health Sci. 2021;5(2): 53-61

Kurt A, Tosun MS, Altuntaş N. Diagnostic accuracy of complete blood cell count and neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and platelet-to-lymphocyte ratios for neonatal infection. Asian Biomed. 2022;16(1):43-52.

Zhang S, Luan X, Zhang W, Jin Z. Platelet-to-lymphocyte and neutrophil-to-lymphocyte ratio as predictive biomarkers for early-onset neonatal sepsis. Birth. 2021;18(36):144.

Ruslie R, Tjipta D, Samosir C, Hasibuan B. Bacterial pattern and role of laboratory parameters as marker for neonatal sepsis. Earth Environ Sci. 2018;125: 120-57.

Liao D, Li J, Lv J, Sun T, Deng S. Evaluation of the diagnostic value of peripheral blood parameters for neonatal pneumonia. Clin Lab. 2020;66(11):23-9.

Mohamed GB, Sabry NM, Abdel RM, Ahmed HH. Platelet to lymphocyte ratio and neutrophil to lymphocyte ratio as new diagnostic markers for detection of early-onset neonatal sepsis in full-term newborns. Minia J Med Res. 2019;30(3):150-5.