Hematological Parameters as Tools for Screening Neonatal Sepsis in Preterm Neonates

Sharanabasavesh Mangalgi, Pakirappa Thippeswamy Archana, Pradeep Gejjegenahalli Channabasappa Maralusiddappa, Krithika Manne Veerabhadraiah, Bhavyashree Balaji

Abstract

Background and Aim: Neonatal sepsis is a leading cause of morbidity and mortality in preterm neonates. Although blood culture is considered the diagnostic gold standard, its utility is limited by delayed reporting, false-negative results, and contamination. Therefore, this study aimed to evaluate the diagnostic accuracy of hematological indices, including mean platelet volume (MPV), platelet mass index (PMI), MPV-to-total platelet count (MPV/TPC) ratio, platelet distribution width (PDW), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and absolute eosinophil count (AEC), for identifying sepsis in preterm neonates.

Materials and Methods: This retrospective case–control study was conducted at a tertiary care center. Medical records of preterm neonates admitted to the neonatal intensive care unit (NICU) between January 2018, and February 2025 were reviewed. The study group included preterm neonates with culture-positive sepsis, and the control group included those without clinical or culture evidence of sepsis. Gestational age, clinical characteristics, hematological indices, and C-reactive protein (CRP) levels were recorded. Receiver operating characteristic curves were constructed to determine sensitivity, specificity, and predictive values.

Results: The sepsis group had lower platelet count (P = .0065), PMI (P = .0054), and MLR (P < .0001), and higher PDW (P < .0001) and MPV/TPC ratio (P = .025) than the control group. PDW (AUC, 0.935), MLR (AUC, 0.963), and MPV/TPC ratio (AUC, 0.798) exhibited good diagnostic performance. MPV and PLR did not differ between the groups.

Conclusion: Hematological parameters may serve as useful adjuncts for screening for neonatal sepsis in preterm neonates. Further studies are needed to establish their diagnostic utility.