J Pediatr Infect Dis
DOI: 10.1055/s-0044-1800977
Original Article

Neutrophil-to-Lymphocyte Ratio in Neonates: A Predictor of Early-Onset Neonatal Sepsis

1   Department of Pediatrics, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue Province, Vietnam
,
Khanh Linh Tong
2   Department of Pediatrics, Khanh Hoa General Hospital, Khanh Hoa Province, Vietnam
,
Hoang Mai Linh
3   Pediatric Center, Hue Central Hospital, Hue City, Thua Thien Hue Province, Vietnam
› Institutsangaben
Funding The authors received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Abstract

Objective Early-onset neonatal sepsis (EOS) is a common cause of mortality in the neonatal period. The purpose of the study was to determine the value of the neutrophil-to-lymphocyte ratio (NLR) in the early diagnosis of EOS.

Methods This was a prospective cross-sectional study. A total of 102 newborns with early-onset infection (EOI) were enrolled within the first 72 hours of life in the neonatal intensive care unit of a tertiary referral hospital, the largest pediatric center in central Vietnam.

Results Among 102 newborns, 32 were identified as having EOS, while the remaining 70 were classified as EOI. The median NLR value in the EOS group (2.7 [2.0–5.6]) was statistically significantly higher than that in the EOI group (1.7 [1.0–2.4], p < 0.05). The NLR demonstrated a moderate ability to discriminate between EOS and EOI with the area under the curve (AUC) of 73.6% (p < 0.05). An NLR cut-off of 1.87 was found to be optimal, with a sensitivity of 84.4%, a specificity of 60.0%, a positive predictive value of 49.1%, and a negative predictive value of 89.4%. The combination of NLR and C-reactive protein demonstrated the best performance in predicting EOS, with the AUC of 85.3% (95% confidence interval: 76.9–91.5).

Conclusions This study suggests that NLR can be used as an additional diagnostic marker, alongside C-reactive protein, for the early diagnosis of EOS.



Publikationsverlauf

Eingereicht: 11. August 2024

Angenommen: 22. November 2024

Artikel online veröffentlicht:
26. Dezember 2024

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  • References

  • 1 National Institute for Health and Care Excellence. Neonatal infection: antibiotics for prevention and treatment. National Institute for Health and Care Excellence (NICE) 2021. Accessed December 4, 2024 at: https://www.nice.org.uk/guidance/ng195
  • 2 Celik IH, Hanna M, Canpolat FE, Pammi Mohan. Diagnosis of neonatal sepsis: the past, present and future. Pediatr Res 2022; 91 (02) 337-350
  • 3 De Alarcón PA, Werner EJ, Christensen RD, Sola-Visner MC. eds. Neonatal hematology: pathogenesis, diagnosis, and management of hematologic problems. New York, NY: Cambridge University Press; 2021
  • 4 Buescher ES, Pedro A, de Alarcon PA. Neutrophil function and disorders of neutrophils in the newborn. In: de Alarcón PA, Werner EJ. eds. Neonatal Hematology. New York, NY: Cambridge University Press; 2005: 254
  • 5 Puopolo KM, Benitz WE, Zaoutis TE. COMMITTEE ON FETUS AND NEWBORN, COMMITTEE ON INFECTIOUS DISEASES. Management of neonates born at ≤ 34 6/7 weeks' gestation with suspected or proven early-onset bacterial sepsis. Pediatrics 2018; 142 (06) e20182896
  • 6 Li T, Dong G, Zhang M. et al. Association of neutrophil-lymphocyte ratio and the presence of neonatal sepsis. J Immunol Res 2020; 2020: 7650713
  • 7 Rossi P, Botgros R, Tibby S. et al. Report on the expert meeting on neonatal and paediatric sepsis. European Medicines Agency. Accessed December 4, 2024 at: https://www.ema.europa.eu/en/documents/report/report-expert-meeting-neonatal-and-paediatric-sepsis_en.pdf
  • 8 Dobrijević D, Vilotijević-Dautović G, Katanić J, Horvat M, Horvat Z, Pastor K. Rapid triage of children with suspected COVID-19 using laboratory-based machine-learning algorithms. Viruses 2023; 15 (07) 1522
  • 9 Dobrijević D, Katanić J, Todorović M, Vučković B. Baseline laboratory parameters for preliminary diagnosis of COVID-19 among children: a cross-sectional study. Sao Paulo Med J 2022; 140 (05) 691-696
  • 10 Dobrijević D, Andrijević L, Antić J, Rakić G, Pastor K. Hemogram-based decision tree models for discriminating COVID-19 from RSV in infants. J Clin Lab Anal 2023; 37 (06) e24862
  • 11 Dobrijević D, Antić J, Rakić G, Katanić J, Andrijević L, Pastor K. Clinical hematochemical parameters in differential diagnosis between pediatric SARS-CoV-2 and influenza virus infection: an automated machine learning approach. Children (Basel) 2023; 10 (05) 761
  • 12 Karabulut B, Alatas SO. Diagnostic value of neutrophil to lymphocyte ratio and mean platelet volume on early onset neonatal sepsis on term neonate. J Pediatr Intensive Care 2021; 10 (02) 143-147
  • 13 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 (01) e12891
  • 14 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 Res Rev News 2022; 16 (01) 43-52
  • 15 Wilar R. Diagnostic value of eosinopenia and neutrophil to lymphocyte ratio on early onset neonatal sepsis. Korean J Pediatr 2019; 62 (06) 217-223
  • 16 Cao C, Wang S, Liu Y. et al. Factors influencing C-reactive protein status on admission in neonates after birth. BMC Pediatr 2024; 24 (01) 89
  • 17 Hofer N, Müller W, Resch B. Non-infectious conditions and gestational age influence C-reactive protein values in newborns during the first 3 days of life. Clin Chem Lab Med 2011; 49 (02) 297-302