Document Detail

Combining Immature and Total Neutrophil Counts to Predict Early Onset Sepsis in Term and Late Preterm Newborns: Use of the I/T2.
MedLine Citation:
PMID:  24503598     Owner:  NLM     Status:  Publisher    
BACKGROUND:: The absolute neutrophil count and the immature/total neutrophil ratio (I/T) provide information about the risk of early-onset sepsis in newborns. However, it is not clear how to combine their potentially overlapping information into a single likelihood ratio.
METHODS:: We obtained electronic records of blood cultures and of complete blood counts with manual differentials drawn <1 hour apart on 66,846 infants ≥34 weeks gestation and <72 hours old born at Kaiser Permanente Northern California and Brigham and Women's Hospitals. We hypothesized that dividing the immature neutrophil count (I) by the total neutrophil count (T) squared (=I/T) would provide a useful summary of the risk of infection. We evaluated the ability of the I/T to discriminate newborns with pathogenic bacteremia from other newborns tested using the area under the receiver operating characteristic curve (c).
RESULTS:: Discrimination of the I/T (c=0.79; 95% CI: 0.76, 0.82) was similar to that of logistic models with indicator variables for each of 24 combinations of the absolute neutrophil count and the proportion of immature neutrophils (c =0.80, 95% CI: 0.77, 0.83). Discrimination of the I/T improved with age, from 0.70 at <1 hour to 0.87 at ≥4 hours. However, 60% of I/T had likelihood ratios of 0.44 to 1.3, thus only minimally altering the pretest odds of disease.
CONCLUSIONS:: Calculating the I/T could enhance prediction of early onset sepsiss, but the CBC will remain helpful mainly when done at >4 hours of age and when the pretest probability of infection is close to the treatment threshold.
Thomas B Newman; David Draper; Karen M Puopolo; Soora Wi; Gabriel J Escobar
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-2-5
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  -     ISSN:  1532-0987     ISO Abbreviation:  Pediatr. Infect. Dis. J.     Publication Date:  2014 Feb 
Date Detail:
Created Date:  2014-2-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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