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INTRODUCTION
Neonatal sepsis is described as a suspected or demonstrated infection in newborn, a systemic inflammatory response syndrome with variable sign and symptoms caused by pathogens with or without accompanying bacteremia.1 The incidence of Neonatal sepsis is approximately 8 per 1000 live births and as high as 13 to 27 per 1000 for newborns weighing < 1500 gms.2 Neonatal septicemia is responsible for 1.5 to 2.0 million deaths/year or between 4000 to 5000 deaths/day in the underneath advanced countries of the world.3 Two thirds of the world’s neonatal deaths occur in just 10 countries, frequently in Asia. Pakistan accounts for 7% of global neonatal deaths. The predominant causes are infections (36%), preterm births (28%) and birth asphyxia (23%) accounting for about 87% of neonatal deaths worldwide.4
Risk factors for neonatal sepsis are low birth weight infants, birth asphyxia, respiratory compromise at birth, maternal risk factors and congenital anomalies.5 Diagnostic tools for identification of EOS includes prenatal screening of high risk mothers to clinical and laboratory identification of newborns with presumed sepsis. Various diagnostic tools have been extensively studied over many years for EOS like WBC, BANDS, ANC, immature to total neutrophil ratio, CRP, interleukin six, procalcitonin.
Blood culture remains a gold standard for diagnosing neonatal sepsis but results are typically obtained after three to five days and its accuracy varies between eight and 73% in various studies.6 However, there are some screening tests (WBC, Platelets, Micro Erythrocyte sedimentation rate (ESR), Absolute Neutrophilic Count (ANC), C-Reactive Protein (CRP), (I/T) ratio, nitroblue teterazolium (NBT), serial Interleukin-6 (IL-6) and pro-calcitonin) that could predict sepsis within 6 to 8 hours.7 The ANC (<1000/ul) and the I/T ratio (> 0.2)give the clue about the early-onset sepsis in newborns.8 Rapid diagnostic tests like CRP, WBC indices may be used as a screening approach for early diagnosis and treatment of sepsis.9
In a prospective study by Kredit T et al in 185 neonates, showed a high NPV of CRP and I/T ratio in early and late onset infection (90% to 98%).10 The sensitivity of I/T ratio has ranged from 60 to 90%. Therefore, when diagnosing neonatal sepsis, the elevated I/T ratio values should be considered in conjunction with other clinical signs.11 From previous studies it was concluded that I/T ratio of >0.80...