The Role of Red Cell Distribution Width in the Diagnosis and Outcome of Neonatal Sepsis in Term Neonates
Keywords:
Red Cell, Neonatal Sepsis, Term NeonatesAbstract
Background: Neonatal sepsis is one of the most critical illnesses in newborns with significant morbidity and mortality, particularly in developing countries. Previous studies showed that red blood cell distribution width (RDW) can be used as a prognostic and diagnostic index in various non-hematological diseases.
Objective: to evaluate the role of RDW in diagnosis and predicting outcome of neonatal sepsis in term neonates.
Patients and Methods: This is a prospective observational study including 75 term neonates with neonatal sepsis and other 50 healthy neonates as controls. The following data were collected :- Mother data included medical and obstetric history, mode of delivery and any prenatal problems; neonatal data including gestational age, sex, clinical presentation; and laboratory assessment in the form of complete blood count, C-reactive protein, blood culture and urine culture.
Results: Neonates with sepsis demonstrated higher mean of RDW (17.82±1.38%) than controls (15.62±0.96% with a highly significant difference. The area under the curve (AUC) for RDW was 0.907, 95% CI= 0.847-0.966, p<0.001. The test's sensitivity and specificity were 92% and 88%, respectively at a cut-off value of RDW= 16.45%. Furthermore, dead neonates had higher mean of RDW (19.46±1.61%) than survived neonates (17.38±0.9%) with a highly significant difference. The AUC of RDW in predicting mortality was 0.852, 95% CI= 0.693-1.0, p<0.001. The test's sensitivity and specificity were 80% and 93%, respectively at a cut-off value of RDW= 18.55%.
Conclusions: The RDW increases significantly in neonatal sepsis compared with healthy neonates. The RDW has a very good diagnostic value in detection of neonatal sepsis with a sensitivity of 92% and specificity of 88%. The RDW could effectively predict mortality in neonatal sepsis with a sensitivity and specificity of 80% and 93%, respectively at cut off value of 18.55%.
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References
Seale AC, Blencowe H, Manu AA, Nair H, Bahl R, Qazi SA, Zaidi AK. 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.
Robert M. Kliegman & Joseph W. St Geme .Epidemiology of infection. David B. Haslam .Nelson textbook of pediatrics 21th edition. May /2019.
GBD .Disease and Injury Incidence and Prevalence Collaborators, a systematic analysis for the global burden of disease study 2017. November 10, 2018; 392:1789–858.6736(18)32279-7.
Nikpay S, YadegarAzadi A, Mohamadi J, et al. Epidemiologic Indicators of Neonatal Sepsis in Teaching Hospitals of Ilam, Western Iran during (2012-2017). Int J Pediatr 2018; 6(7): 7947-58.
Omer IM, Mohammed BA. A study of red cell distribution width and neonatal sepsis at Soba University Hospital, Khartoum, Sudan. Sudanese J Pediatr 2021;21(1):42-47.
Chan GJ, Lee AC, Baqui AH, Tan J, Black RE. Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review andmeta-analysis. PLoS Med. 2013;10(8):e1001502.
Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Early onset sepsis in VLBW neonates report from the national institute of child health and human development neonatal research network. J Pediatr, 2012;129(1):72–8.
Hodeib, M., Morgan, D., Hedaya, A. et al. A study of elevated red cell distribution width (RDW) in early-onset neonatal sepsis. Egypt Pediatric Association Gaz 2021;70,21.
Chen J, Jin L, Yang T. Clinical study of RDW and prognosis in sepsis new borns. Biomed Res 2015;25(4):576–579.
Cosar H, Yilmaz O, Temur M. Relationship between Early-Onset Neonatal Sepsis and Red Blood Cell Distribution Width (RDW), J Hematol Thrombo Dis 2017, 5:2.
Vayá A, Sarnago A, Fuster O, Alis R, Romagnoli M. Influence of inflammatory and lipidic parameters on red blood cell distribution width in a healthy population. Clin Hemorheol Microcirc. 2015;59(4):379-385.
Karabulut B, Arcagok BC. New diagnostic possibilities for early onset neonatal sepsis: red cell distribution width to platelet ratio, Fetal Pediatr. Pathol. 2019: 1–10.
Chen PC, Sung FC, Chien KL, et al. Red blood cell distribution width and risk of cardiovascular events and mortality in a community cohort in Taiwan. Am J Epidemiol 2010;171:214–220.
Lippi G, Targher G, Montagnana M, et al. Relationship between red blood cell distribution width and kidney function tests in a large cohort of unselected outpatients. Scand J Clin Lab Investig 2008;68:745–748
Rabie EM, El-Sokkary MM, Bassiouny MR, et al. Epidemiology of neonatal sepsis and implicated pathogen: as tudy from Egypt. Biomed Res Int. 2015;15:1–11.
Jajoo M, Kapoor K, Garq LK, et al. A study the incidence and risk factors of early onset neonatal sepsis in an out born neonatal intensive care unit of India. J Clin Neonatal. 2015;4(2):91–5.
Sadaka F, O’Brien J, Prakash S, et al. Red cell distribution width and outcome in patients with septic shock, J. Intensive Care Med. 2013;28:307–313
Ellahony DM, El-Mekkawy MS, Farag MM. A Study of Red Cell Distribution Width in Neonatal Sepsis. Pediatr Emerg Care. 2020; 36(8): 378-383.
Abdullah ST, Moustafa AN, Anwar AM, et al. Prognostic validity of red cell distribution width in neonatal sepsis. Int J Pediatr 2018; 6(11): 8579-86.
Aksoy HT, Eras Z, Canpolat E, Dilmen U. Does red cell distribution width predict mortality in newborns with early sepsis?. Am J Emerg Med. 2013; 31(7):1150.
Lee CC, Chen SY, Tsai CL, et al. Prognostic value of mortality in emergency department sepsis score, procalcitonin, and C-reactive protein in patients with sepsis at the emergency department. Shock. 2018; 29(3): 322-327.
Lippi G, Targher G, Montagnana M, et al. Relationship between red blood cell distribution width and kidney function tests in a large cohort of unselected outpatients. Scand J Clin Lab Investig 2008;68:745–748
