Early Predictors of Neonatal Sepsis and Their Association with Clinical Outcomes in New-borns Admitted to a Neonatal ICU

Abstract

Background: Neonatal sepsis remains an important cause of morbidity and mortality in neonatal intensive care units (NICUs). Diagnosis is challenging because clinical manifestations are frequently nonspecific, while blood culture results may take time and can be affected by prior antibiotic exposure. Early identification of clinical and laboratory predictors may facilitate timely treatment and improve outcomes. Aim: To identify early clinical and laboratory predictors of neonatal sepsis and evaluate their association with short-term clinical outcomes among neonates admitted to a tertiary-care NICU. Methods: A prospective observational study was conducted over 24 months in the Department of Neonatology, Rajendra Institute of Medical Sciences, Ranchi. One hundred neonates with clinical suspicion of sepsis were enrolled. Maternal, perinatal, clinical and laboratory parameters were recorded at admission. Complete blood count, absolute neutrophil count, immature-to-total neutrophil ratio, platelet count, C-reactive protein (CRP), procalcitonin (PCT), blood culture and other relevant investigations were performed. Neonates were followed until discharge or death. Predictors of sepsis and adverse outcomes were assessed using univariate and multivariable logistic regression. Results: Of 100 neonates, 42 (42.0%) fulfilled criteria for culture-proven/probable neonatal sepsis. Preterm birth, birth weight <2.5 kg, prolonged rupture of membranes, respiratory distress, temperature instability, poor feeding, lethargy, thrombocytopenia, elevated CRP and elevated PCT were significantly more frequent among septic neonates. CRP ?10 mg/L and PCT ?2 ng/mL were particularly associated with sepsis. Neonates with sepsis had higher requirements for respiratory support, longer NICU stay and greater mortality. On multivariable analysis, elevated PCT (adjusted odds ratio [aOR] 4.18; 95% CI 1.71–10.21; p=0.002), elevated CRP (aOR 3.46; 95% CI 1.45–8.27; p=0.005), thrombocytopenia (aOR 3.21; 95% CI 1.31–7.84; p=0.011) and respiratory distress (aOR 2.87; 95% CI 1.18–6.96; p=0.019) remained independently associated with sepsis. Conclusion: A combination of clinical signs and early laboratory markers, particularly CRP, PCT and platelet count, may help identify neonates at increased risk of sepsis and adverse outcomes. A multimodal approach rather than reliance on a single biomarker may support earlier recognition and appropriate management.