| Interpreting complete blood counts soon after birth in newborns at risk for sepsis. | |
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MedLine Citation:
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PMID: 20974782 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: A complete blood count (CBC) with white blood cell differential is commonly ordered to evaluate newborns at risk for sepsis. OBJECTIVES: To quantify how well components of the CBC predict sepsis in the first 72 hours after birth. METHODS: For this retrospective cross-sectional study we identified 67 623 term and late-preterm (≥ 34 weeks gestation) newborns from 12 northern California Kaiser hospitals and 1 Boston, Massachusetts hospital who had a CBC and blood culture within 1 hour of each other at <72 hours of age. We compared CBC results among newborns whose blood cultures were and were not positive and quantified discrimination by using receiver operating characteristic curves and likelihood ratios. RESULTS: Blood cultures of 245 infants (3.6 of 1000 tested newborns) were positive. Mean white blood cell (WBC) counts and mean absolute neutrophil counts (ANCs) were lower, and mean proportions of immature neutrophils were higher in newborns with infection; platelet counts did not differ. Discrimination improved with age in the first few hours, especially for WBC counts and ANCs (eg, the area under the receiver operating characteristic curve for WBC counts was 0.52 at <1 hour and 0.87 at ≥ 4 hours). Both WBC counts and ANCs were most informative when very low (eg, the likelihood ratio for ANC < 1000 was 115 at ≥ 4 hours). No test was very sensitive; the lowest likelihood ratio (for WBC count ≥ 20 000 at ≥ 4 hours) was 0.16. CONCLUSION: Optimal interpretation of the CBC requires using interval likelihood ratios for the newborn's age in hours. |
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Authors:
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Thomas B Newman; Karen M Puopolo; Soora Wi; David Draper; Gabriel J Escobar |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2010-10-25 |
Journal Detail:
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Title: Pediatrics Volume: 126 ISSN: 1098-4275 ISO Abbreviation: Pediatrics Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-02 Completed Date: 2010-11-22 Revised Date: 2011-10-21 |
Medline Journal Info:
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Nlm Unique ID: 0376422 Medline TA: Pediatrics Country: United States |
Other Details:
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Languages: eng Pagination: 903-9 Citation Subset: AIM; IM |
Affiliation:
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Department of Epidemiology and Biostatistics, University of California, San Francisco, Box 0560, San Francisco, CA 94143, USA. newman@epi.ucsf.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Bacteremia / blood, diagnosis Blood Cell Count* California Cross-Sectional Studies Female Humans Infant Infant, Newborn Infant, Newborn, Diseases / blood*, diagnosis Infant, Postmature / blood* Leukocyte Count Likelihood Functions Male Massachusetts Neutrophils Predictive Value of Tests Reference Values Sepsis / blood*, diagnosis |
| Grant Support | |
ID/Acronym/Agency:
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R01-GM-80180-3/GM/NIGMS NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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