Diagnostic and Prognostic Values of CBC Indices and Serum Lactate in Neonatal Sepsis
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 80
研究概览
简要总结
Neonatal sepsis is a leading cause of illness and death in Neonatal Intensive Care Units (NICUs). Diagnosing it quickly is challenging because the early signs often overlap with other common newborn health issues. While a blood culture is the most accurate way to confirm an infection, the results can take 48 to 72 hours. This delay highlights the need for faster, more accessible diagnostic tools.
This observational study aims to find quicker ways to diagnose neonatal sepsis and predict its severity using readily available blood tests. Researchers are investigating whether specific details from a standard Complete Blood Count (CBC), such as the variation in red blood cell size (RDW), the average size of platelets (MPV), and the ratio of immature to total white blood cells (I/T ratio), combined with serum lactate levels (a marker of tissue oxygenation and stress) can serve as reliable, early warning signs.
The study will enroll newborns (0 to 28 days old) admitted to the NICU who show clinical signs of a possible infection. Upon admission and before starting any antibiotic treatment, a small blood sample will be drawn to measure these CBC indices and serum lactate, alongside the standard blood culture.
By comparing these rapid blood test results with the final blood culture outcomes and the infants' overall clinical progress in the NICU, the research team hopes to determine if this simple combination of markers can help doctors diagnose sepsis earlier, anticipate the severity of the illness, and make faster, life-saving treatment decisions.
详细描述
Neonatal sepsis remains one of the most devastating conditions encountered in neonatal intensive care units (NICUs) worldwide. The global population-level incidence of neonatal sepsis is estimated at approximately 2,202 cases per 100,000 live births, with mortality ranging between 11% and 19%. Diagnosis is clinically challenging because signs are nonspecific and overlap with other neonatal conditions. Although blood culture is the gold standard for diagnosis, it has significant limitations, including a 48 to 72-hour delay for results, low sensitivity due to the small blood volumes collected from neonates, and the risk of contamination. Complete blood count (CBC) indices, including the absolute neutrophil count, immature-to-total neutrophil (I/T) ratio, mean platelet volume (MPV), and red cell distribution width (RDW), have attracted interest as accessible screening tools. Furthermore, serum lactate is an established critical prognostic biomarker that reflects tissue hypoperfusion and anaerobic metabolism. This study aims to evaluate the combined diagnostic and prognostic values of these CBC-derived indices and serum lactate in a resource-limited NICU environment.
Upon admission to the NICU, every enrolled neonate will undergo a comprehensive clinical assessment.
- Maternal and perinatal history will be extracted from obstetric records, including details such as maternal age, duration of premature rupture of membranes (PROM), intrapartum fever, maternal urinary tract infections, Group B Streptococcus (GBS) status, and mode of delivery.
- Continuous physiologic monitoring will record heart rate, respiratory rate, and oxygen saturation.
- Core body temperature will be assessed continuously using skin temperature probes.
- An attending neonatologist will conduct a physical examination to document clinical signs of sepsis, including feeding intolerance, abdominal distension, lethargy, hypotonia, apnea, chest retractions, cyanosis, and altered capillary refill time.
To prevent pre-analytical errors and sample contamination, a strict aseptic blood sampling protocol will be executed prior to the administration of any empirical antimicrobial therapy.
- Skin antisepsis will be performed using a two-step technique with 70% isopropyl alcohol followed by 2% chlorhexidine gluconate, which will be allowed to air-dry completely.
- A precise volume of 3.0 to 4.0 mL of peripheral venous blood will be extracted.
- The blood will be distributed in a strict order of draw: 1.0 to 2.0 mL for the pediatric aerobic blood culture bottle, 1.0 mL into a gray-top tube containing Sodium Fluoride and Potassium Oxalate to halt glycolysis for lactate testing, and 1.0 mL into a purple-top K2EDTA tube for the CBC.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 0 Days 至 28 Days（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Neonates aged 0 to 28 days (term and preterm).
- •Presence of two or more clinical signs highly suggestive of sepsis (e.g., temperature instability [< 36.5°C or > 37.5°C], tachycardia/bradycardia, tachypnea, feeding intolerance, lethargy, or altered muscle tone).
- •Informed written consent obtained from the parents or legal guardians.
排除标准
- •Neonates with severe congenital anomalies or chromosomal abnormalities.
- •Neonates diagnosed with Inborn Errors of Metabolism (which inherently alter lactate levels).
- •Neonates with severe perinatal asphyxia or Hypoxic-Ischemic Encephalopathy (HIE), as these conditions cause profound primary lactic acidosis independent of sepsis.
- •Neonates who received prior broad-spectrum intravenous antibiotics for more than 24 hours prior to admission.
- •Neonates who have received prior blood transfusions.
- •Neonates requiring immediate surgical intervention.
研究组 & 干预措施
Neonates with Suspected Sepsis
This cohort includes term and preterm neonates aged 0 to 28 days admitted to the Neonatal Intensive Care Unit (NICU) presenting with two or more clinical signs highly suggestive of sepsis (e.g., temperature instability, tachycardia/bradycardia, tachypnea, feeding intolerance, lethargy, or altered muscle tone). Upon admission and prior to the administration of any empirical antimicrobial therapy, peripheral venous blood samples will be drawn to evaluate Complete Blood Count (CBC) indices, quantify serum lactate levels, and perform a blood culture. As this is an observational study, no experimental interventions or medications will be administered to this group.
研究者
Faten Samir Malak Nashed
Pediatric Resident
Assiut University