Variation in Platelet Count and Platelet Indices with Their Clinical Correlation in Neonatal Sepsis

Abstract

Introduction: Neonatal sepsis is a major cause of neonatal morbidity and mortality. Early diagnosis remains challenging because clinical manifestations are often nonspecific and conventional diagnostic methods such as blood culture are time-consuming. Platelet count and platelet indices have emerged as potential adjunctive biomarkers for diagnosis and prognosis in neonatal sepsis.

Aim: To evaluate variations in platelet count, mean platelet volume (MPV), and platelet distribution width (PDW) and determine their clinical correlation in neonatal sepsis.

Methodology: A hospital-based observational cross-sectional study was conducted among 100 neonates (0–28 days) with suspected sepsis admitted to the neonatal unit of Dr. B.C. Roy PGIPS, Kolkata, from February 2021 to October 2022. Complete blood count, platelet indices, sepsis screen, and blood culture were performed. Platelet count <1.5 lakh/cumm, MPV >10.8 fL, and PDW >13% were considered abnormal. Diagnostic performance and prognostic significance were analyzed using appropriate statistical tests and ROC curve analysis.

Results: Among 100 neonates, 55% were culture-positive and 56% had late-onset sepsis. Thrombocytopenia was present in 97% of cases, while elevated MPV and PDW were observed in 57.35% and 58.82% respectively. Severe thrombocytopenia was significantly associated with mortality (77.78%, p<0.0001). Expired neonates had significantly lower platelet counts and higher MPV and PDW values than survivors (p<0.001). For predicting mortality, MPV >12.1 fL demonstrated 84.21% sensitivity and 91.84% specificity (AUC=0.913), while PDW >15.3% showed 84.21% sensitivity and 87.76% specificity (AUC=0.908). MPV emerged as the best predictor of mortality.

Conclusion: Thrombocytopenia, elevated MPV, and increased PDW are significantly associated with neonatal sepsis and adverse outcomes. These inexpensive and readily available platelet parameters may serve as useful adjunctive diagnostic and prognostic markers in neonatal sepsis, particularly in resource-limited settings.