Ethylenediaminetetraacetic acid (EDTA)�Cmixed venous blood was used to estimate hemoglobin (Hb), total leukocyte count, and platelet count. Citrated blood was used to estimate plasma fibrinogen level. For estimation of serum IgM and C-reactive fda approved protein (CRP), clotted blood was used. To estimate micro-erythrocyte sedimentation rate (m-ESR), capillary blood was taken in a heparinized micro-hematocrit tube. Blood smears were made on glass slides for differential leukocyte count, absolute neutrophil count, morphological changes in neutrophils (toxic granules, vacuoles, and Dohle bodies in the cytoplasm), and ratio of immature to total neutrophils (I/T ratio). Plasma fibrinogen was estimated by a reagent kit that was based on a modified Clauss method. A diagnostic kit was also used to determine serum IgM level by an immunochemical assay.

The cutoff values of the tests were taken from the literature and diagnostic kits. Statistical analysis was done using SPSS? software, version 17. Among the 62 clinically suspected cases, blood culture was positive in 38 cases and these were regarded as proven cases. In 24 cases, though the blood culture reports were negative, there was strong clinical suspicion of neonatal sepsis, which was supported by other laboratory tests; this second group was regarded as probable cases. RESULTS In the present study, of the 62 cases, 38 had positive blood culture reports (proven cases). Gram-negative organisms were commoner (n=26; 68.4%) than gram-positive organisms (n=12; 31.6%). Klebsiella pneumoniae was the commonest bacteria (52%), followed by Staphylococcus aureus (26%).

In one case there was mixed infection with K pneumoniae and S aureus. Twelve neonates suffering from gram-negative bacteremia and four neonates suffering from gram-positive bacteremia died despite treatment [Table 1]. Table 1 Bacteriological profile in blood culture�Cpositive cases (proven cases) (n=38) Of the 38 proven cases, 32 (84%) were low birth weight (LBW) infants (weight <2.5 kg), whereas 14/38 (37%) were preterm infants (<37 weeks of gestational age). Among all the tests performed, four tests (CRP, m-ESR, I/T ratio, and morphological changes in the neutrophils) proved to be very useful tests to diagnose the early neonatal sepsis and test results were statistically significant [Table 2]. CRP had the highest sensitivity (84%) and m-ESR had the highest specificity (94%).

The highest positive predictive accuracy of 92% was seen with m-ESR. We found that specificity and positive predictive value increased when the results of these tests were considered together. When two tests turned out to be positive the specificity and positive predictive value were 84% and 85%, respectively. When three tests showed positive results the Drug_discovery specificity and positive predictive value were 88% and 95%, respectively.