COMPARISON OF SEPSIS BIOMARKER PERFORMANCE IN PRETERM VS TERM NEONATES WITH SUSPECTED SEPSIS

Abstract

Background: The clinical utility of hematologic inflammatory markers in neonatal sepsis is gaining recognition, but gestational age may significantly impact their diagnostic accuracy.

Objective: To evaluate and compare the diagnostic utility of Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), derived NLR (dNLR), and Neutrophil-Lymphocyte-Platelet Ratio (NLPR) in preterm and term neonates with early- and late-onset sepsis.

Methods: A subgroup analysis was conducted from a prospective observational study of 147 neonates with suspected sepsis. Subjects were stratified into preterm (<37 weeks) and term (≥37 weeks) groups. Biomarkers were compared between groups using ROC curve analysis to determine sensitivity, specificity, and area under the curve (AUC).

Results: Of 147 neonates, 89 were preterm and 58 term. Inflammatory markers (NLR, dNLR, NLPR) showed stronger diagnostic performance in term neonates with late-onset sepsis (AUCs > 0.80), while preterm neonates demonstrated reduced discriminatory ability (AUCs 0.6–0.7). PLR consistently had the lowest diagnostic value in both groups.

Conclusion: The diagnostic utility of sepsis biomarkers is influenced by gestational maturity. NLR, dNLR, and NLPR perform better in term neonates. Future research should consider gestational age-specific cutoffs to enhance sepsis diagnosis.