UTILIZATION OF IT2 RATIO IN PREDICTING NEONATAL SEPSIS
Santosh T Soans ,Swathi S Sanjee, Ashwij Shriyan
Professor and Head of Department
Neonatologist and Consultant Paediatrician
Department of Paediatrics, A J Institute of Medical Sciences, Mangalore
Background: The absolute neutrophil count and the immature/total neutrophil ratio (I/T)provide information about the risk of sepsis in newborns.High I/T is more worrisome when the total neutrophil count is low. Hence by dividing the I/T by the total neutrophil count again, i.e.,calculating IT2, we hypothesized that we might capture this worrisome combination of ahigh I/T and low total neutrophil count with a single number. The primary objective of the study was to evaluate the ability of I/T2 to discriminate newborns with Sepsis.
Methodology: Prospective comparative study was done between December 2016 and August 2017 in AJIMS NICU, Mangalore. Blood culture and Complete blood counts were done for all the clinically suspected sepsis babies admitted to the NICU. ANC, IT and IT2 ratios were calculated and analysed individually for Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value. Blood culture was considered as gold standard for the diagnosis of Sepsis.
Results:A total of 140 cases were analysed during the study period. Among them, 33 cases were culture positive and 107 were culture negative. Among the 33 culture positive cases, 24 were early onset sepsis and 9 were late onset sepsis. IT2 showed a sensitivity of 24.2%,specificity of 78.2%, and a PPV 19% and NPV 74.4%.It was more significant when the ANC was in the range of 1-1.99
IT Ratio IT2 Ratio
Sensitivity 15.2% 24.2%
Specificity 65% 78.2%
Positive Predictive Value 7% 19%
Negative Predictive Value 59.2% 74.4%
Conclusion: IT2 ratio could enhance the prediction of Neonatal sepsis., but further studies with a larger sample size is required in this aspect.
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