A STUDY OF PLATELET COUNTS IN PROVEN NEONATAL SEPSIS AND ASSOCIATION WITH ETIOLOGICAL PROFILE IN A TERTIARY CARE NICU, JAIPUR
Main Article Content
Keywords
Neonatal sepsis, thrombocytopenia, platelet count, blood culture, Klebsiella pneumoniae.
Abstract
Background: Neonatal sepsis remains a major cause of neonatal morbidity and mortality, particularly in developing countries. Early diagnosis is challenging because of nonspecific clinical manifestations and the limited sensitivity of blood culture, which remains the gold standard diagnostic test. Thrombocytopenia is one of the most common hematological abnormalities observed in neonatal sepsis and may serve as a useful marker for early diagnosis and disease severity. This study was conducted to evaluate platelet counts in culture-proven neonatal sepsis and determine their association with the etiological profile of infecting organisms.
Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) of Mahatma Gandhi Medical College and Hospital, Jaipur. Neonates with clinical suspicion of sepsis underwent blood culture and hematological evaluation. Only culture-positive cases were included in the study. Demographic characteristics, risk factors, clinical features, platelet counts, and microbiological profiles were recorded and analyzed.
Results: Among 1,489 NICU admissions, 440 neonates were clinically suspected of sepsis, of whom 102 (23.18%) had culture-proven sepsis. Early-onset sepsis accounted for the majority of cases (69.61%), and male neonates constituted 63.73% of affected infants. Moderate-to-severe thrombocytopenia was significantly more common among culture-positive neonates than culture-negative neonates (OR = 90.23; 95% CI: 39.9–204.2; p < 0.0001).
Conclusion: Thrombocytopenia is a common hematological abnormality in neonatal sepsis and shows a strong association with culture-proven infection. Moderate-to-severe thrombocytopenia may serve as a useful adjunctive marker for the early diagnosis and prognostic assessment of neonatal sepsis. Although Gram-negative organisms were associated with greater platelet depletion, platelet count alone could not reliably predict the causative pathogen. Routine monitoring of platelet counts may aid in the early identification of high-risk neonates and facilitate timely therapeutic intervention.
References
2. Murthy S, Godinho MA, Guddattu V, et al. Risk factors of neonatal sepsis in India: A systematic review and meta-analysis. PLoS One. 2019;14(4).
3. Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration. Lancet Glob Health. 2016;4–e760.
4. Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed. 2015;100–F263.
5. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017;390(10104):1770–1780.
6. Camacho-Gonzalez A, Spearman PW, Stoll BJ. Evaluation of neonatal sepsis. Pediatr Clin North Am. 2013;60:367–389.
7. Semple JW, Italiano JE Jr, Freedman J. Platelets and the immune continuum. Nat Rev Immunol. 2011;11:264–274.
8. Gauer RL, Braun MM. Thrombocytopenia. Am Fam Physician. 2012 Mar 15;85(6):612-22.
9. Levi M, van der Poll T. Coagulation and sepsis. Thromb Res. 2017;149:38–44.
10. Ree IMC, Fustolo-Gunnink SF, Bekker V, et al. Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS One. 2017;12.
11. Catal F, Tayman C, Tonbul A, et al. Diagnostic and prognostic value of MPV in neonatal sepsis. Clin Lab. 2014;60:1193–1200.
12. Choudhary DK, Tiwari AK, Narang S, Chhabra J. Correlation of platelet count and platelet indices with neonatal sepsis-diagnostic and prognostic indicator. J PediatrRes. 2017;4(08):511-518
13. Panda SK, Nayak MK, Thangaraj J, et al. Platelet parameters as a diagnostic marker in neonatal sepsis. J Family Med Prim Care. 2022;11:1748–1754.
14. Nandyal SS, Shashikala P, Sahgal V. Study of thrombocytopenia in neonatal intensive care unit. Indian Journal of Pathology and Oncology, January - March 2016;3(1);55-59.
15. Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. 2018 Mar;6(3):223-230. doi: 10.1016/S2213-2600(18)30063-8.
16. Seale AC, Blencowe H, Manu AA, Nair H, Bahl R, Qazi SA, Zaidi AK, Berkley JA, Cousens SN, Lawn JE; pSBI Investigator Group. Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis. Lancet Infect Dis. 2014 Aug;14(8):731-741. doi: 10.1016/S1473-3099(14)70804-7.
17. Polin RA; Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics. 2012 May;129(5):1006-15. doi: 10.1542/peds.2012-0541.
18. Lamy B, Dargère S, Arendrup MC, Parienti JJ, Tattevin P. How to Optimize the Use of Blood Cultures for the Diagnosis of Bloodstream Infections? A State-of-the Art. Front Microbiol. 2016 May 12;7:697. doi: 10.3389/fmicb.2016.00697.
19. Klinger G, Levy I, Sirota L, Boyko V, Reichman B, Lerner-Geva L; Israel Neonatal Network. Epidemiology and risk factors for early onset sepsis among very-low-birthweight infants. Am J Obstet Gynecol. 2009 Jul;201(1):38.e1-6. doi: 10.1016/j.ajog.2009.03.006.
20. Al Ghadeer HA, Alabdallah RH, AlKhalaf GI, Aldandan FK, Almohammed HA, Al Busaeed MM, Alkhawajah FM, Al Hassan KA, Alghadeer FA, Alreqa HH, Al Muaiweed RS, Al Bohassan AS, AlMuhaish AA, Alhabeeb AJ, Alsaif AK. Characteristics and Associated Risk Factors of Neonatal Sepsis: A Retrospective Study From Saudi Arabia. Cureus. 2024 Dec 28;16(12):e76517. doi: 10.7759/cureus.76517.
21. Shah NS, Srivastava R, Mehta T, Shah A, Chandwani C. Study of etiological profile, risk factors and immediate outcome of neonatal sepsis. Int J Contemp Pediatr. 2025;12(5):755-762.
22. Vijayan S, Nair GAV, Narayanan D. Clinical features and septic screen in neonatal sepsis in a teaching hospital in India. Int J Contemp Pediatr. 2020;7(1):46-51. doi:10.18203/2349-3291.ijcp20195724. Kumari J, Kumar N, Bibha K. Maternal and neonatal risk factors for developing early onset newborn sepsis (EONS) in a tertiary care hospital. Int J Pharm Clin Res. 2024;16(6):703-709.
23. Guida JD, Kunig AM, Leef KH, McKenzie SE, Paul DA. Platelet count and sepsis in very low birth weight neonates: is there an organism-specific response? Pediatrics. 2003 Jun;111(6 Pt 1):1411-5. doi: 10.1542/peds.111.6.1411.
24. Talat F, Alam K, Akhtar K, Ali SM. A clinicopathological study of thrombocytopenia and platelet indices in neonatal sepsis. Trends Med Res. 2023;18(1):69-74. doi:10.3923/tmr.2023.69.74.
25. Alharbi AS. Common Bacterial Isolates Associated With Neonatal Sepsis and Their Antimicrobial Profile: A Retrospective Study at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Cureus. 2022 Jan 11;14(1):e21107. doi: 10.7759/cureus.21107.
26. Singh, S., Agrawal, A., Mohan, U., & Awasthi, S. (2018). Prevalence of thrombocytopenia in neonates admitted in NICU with culture proven sepsis. International Journal of Contemporary Pediatrics, 5(3), 743–748.
27. Chate, S., Holikar, S., & Nagare, S. (2019). Prevalence of thrombocytopenia in neonatal sepsis. Indian Journal of Child Health, 6(6), 309-312.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Harsh Jain
PG Resident, Dept. of Paediatrics, Mahatma Gandhi Medical College and Hospital, Jaipur
Dr. Rupesh Masand
Professor & Head, Dept. of Paediatrics, Mahatma Gandhi Medical College and Hospital, Jaipur
Dr Nikita Pal
Assistant Professor, Dept. of Paediatrics, Mahatma Gandhi Medical College and Hospital, Jaipur
Dr Sourabh Singh
Professor, Dept. of Neonatology, Mahatma Gandhi Medical College and Hospital, Jaipur
Dr Abhishek Sharma
Associate Professor, Dept. of Paediatrics, Dr. B. S. Tomar, Institute of Medical Sciences & Research, Jagatpura, Jaipur
Dr Rajveer Singh Yadav
Professor, Dept. of Paediatrics, National Institute of Medical Sciences & Research, Nims University Rajasthan, Jaipur
