Abstract

Background: Neonatal sepsis significantly contributes to neonatal mortality and morbidity in developing countries. The delay in diagnosis due to the time-consuming gold standard blood culture necessitates rapid, accessible, and cost-effective diagnostic markers. Aims: This study aimed to evaluate the sensitivity and specificity of Micro-ESR for early neonatal sepsis diagnosis and compare its effectiveness with other standard markers. Methodology: Conducted at D.Y. Patil Hospital's Department of Pediatrics in Navi Mumbai, this prospective observational study included 200 neonates suspected of sepsis. Blood samples were analyzed for CBC, CRP, Micro-ESR, and bacterial culture before antibiotic initiation. Micro-ESR's diagnostic performance was assessed against other markers based on confirmed sepsis cases via blood culture. Results: Among 200 neonates, 16 had a positive blood culture. Micro-ESR showed a sensitivity of 87.5% and specificity of 28.80%. In comparison, Total Leucocyte Count (TLC) and Absolute Neutrophil Count (ANC) demonstrated higher specificity (91.25% and 70% respectively) but lower sensitivity. Platelet count and CRP indicated high specificity (94.56%) and sensitivity (100%) respectively, albeit with low predictive values. Conclusions: While CRP exhibited the highest sensitivity, TLC and platelet count showed superior specificity. Despite its lower specificity, Micro-ESR's high sensitivity suggests its utility as a supportive early diagnostic marker alongside CBC, CRP, and ANC. Blood culture remains the definitive diagnostic standard.

Description

Neonatal sepsis, presenting with or without bacteremia in the first 28 days of life, encompasses a range of systemic infections including septicemia, pneumonia, and meningitis, among others.1,2 It is a leading cause of neonatal mortality in developing countries, accounting for 30-50% of neonatal deaths annually, with an estimated 20% of neonates developing sepsis.3,4 The risk factors for neonatal sepsis are multifaceted, involving maternal, fetal, and environmental elements. Maternal factors include conditions like premature rupture of membranes and maternal fever, while fetal factors involve birth weight and gestational age. Environmental factors include invasive procedures and nursing care.5,6,7 Neonatal sepsis is classified into Early Onset Sepsis (within 72 hours of birth) and Late-Onset Sepsis (after 72 hours). The clinical signs are diverse and non-specific, making early detection challenging yet crucial for reducing mortality through timely antimicrobial therapy.8,9 Blood culture is the definitive diagnostic standard for neonatal sepsis but is hindered by its requirement for sophisticated labs and trained staff, and its delayed results. Alternative diagnostic tests like CBC, CRP, and procalcitonin offer confirmation but are often costly and not readily available in remote regions.10 Given these challenges, there's a critical need for accessible, cost-effective diagnostic markers with high sensitivity and specificity. Micro-ESR stands out as a promising option, offering simplicity, affordability, and requiring minimal training or equipment, making it suitable for use in remote settings. Its ability to be repeatedly conducted offers additional benefits in monitoring disease progression or treatment response.11 This study aims to assess the sensitivity and specificity of Micro-ESR in early neonatal sepsis detection, comparing it with other blood markers such as total leucocyte count, absolute neutrophil count, platelet count, C-reactive protein, and procalcitonin, to establish its efficacy and potential as a routine diagnostic tool in resource-limited settings.