Use of the Complete Blood Cell Count in Late-onset Neonatal Sepsis

Background: Late-onset sepsis is an important cause of morbidity and mortality in infants. Diagnosis of late-onset sepsis can be challenging. The complete blood cell count and differential have been previously evaluated as diagnostic tools for late-onset sepsis in small, single-center reports. Objective: We evaluated the diagnostic accuracy of the complete blood cell count and differential in late-onset sepsis in a large multicenter population. Study design: Using a cohort of all infants with cultures and complete blood cell count data from a large administrative database, we calculated odds ratios for infection, as well as sensitivity, specificity, positive and negative predictive values and likelihood ratios for various commonly used cut-off values. Results: High and low white blood cell counts, high absolute neutrophil counts, high immature-to-total neutrophil ratios and low platelet counts were associated with late-onset sepsis. Associations were weaker with increasing postnatal age at the time of the culture. Specificity was highest for white blood cell counts <1000/mm(3) and >50,000/mm(3) (>99%). Positive likelihood ratios were highest for white blood cell counts <1000/mm(3) (4.1) and platelet counts <50,000/mm(3) (3.5). Conclusion: No complete blood cell count index possessed adequate sensitivity to reliably rule out late-onset sepsis in this population.