Rodwell et al reported a Hematologic Scoring System (HSS) for identifying a neonate at risk for sepsis. This may be useful for a setting of limited resources. The authors are from Mater Misericordiae Public Hospitals in Brisbane, Australia.
Patient selection: neonate
Parameters:
(1) total leukocyte count per µL and age
(2) absolute neutrophil count
(3) immature PMN
(4) ratio of immature to total PMN count
(5) immature to mature PMN count
(6) platelet count per microliter
(7) degenerative morphological changes in neutrophils (toxic granules, cytoplasmic vacuoles)
Parameter
Finding
Points
total leukocyte count
<= 5,000 per µL
1
>= 25,000 and < 12 hours old
1
>= 30,000 and 12-24 hours old
1
>= 21,000 after 24 hours
1
other
0
absolute neutrophil count
1,800 to 5,400 per µL
0
< 1,800 per µL
1
> 5,400 per µL
1
no mature PMNs seen
2
immature neutrophil count
<= 600 per µL
0
> 600 per µL
1
immature to total PMN ratio
<= 0.12
0
> 0.12
1
immature to mature PMN ratio
<= 0.3
0
> 0.3
1
degenerative changes
no
0
yes
1
platelet count
> 150,000 per µL
0
<= 150,000 per µL
1
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• A score <= 2 indicates alowprobability of infection.
• A score >= 3 is sensitive but not specific for neonatal sepsis.
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