Background: Neonatal sepsis is still a significant cause of neonatal morbidity& mortality and its early diagnosis still remains a challenge. Present study aimed to investigate Red cell Distribution Width (RDW) as a marker of early onset neonatal sepsis (EONS).

Material and Methods: A hospital based cross sectional analytical study was conducted at department of paediatrics, at a tertiary care centre of western India, including 55 early onset neonatal sepsis cases and 55 controls.  Newborn delivered by spontaneous vaginal delivery with gestational age of 36 weeks or more presenting within 72 hours of delivery with signs & symptoms suggestive of early onset neonatal sepsis were taken as cases and age and weight-matched healthy new-born were taken as control. 

Observations: Mean RDW level was significantly higher (p<0.001) in EONS (21.31 ± 3.08 %) as compared to healthy controls (16.23 ± 1.16%). TLC was also significantly higher (p<0.001) in EONS (18.92 ± 8.01x10³/dl) as compared to controls (12.19 ± 9.29x10³/dl). The area under the ROC curve for RDW was 0.988 (0.973 – 1.000), which indicated that RDW was a good predictor of EONS (p<0.001). The Critical cut off point was found to be 18.55 using Youden’s index with a sensitivity of 94.55% and specificity of 96.36% for diagnosis of EONS.

Conclusion: Red cell distribution width can be used as a cheap, easy, rapid and accurate marker for rapid identification of early onset neonatal sepsis.

Keywords: Neonatal sepsis, early onset neonatal sepsis, Red cell distribution width, RDW.

1. Report of National Neonatal Perinatal Database (National Neonatology Forum) 2002-03
2. Ying F, and Jia-Lin Y. Umbilical blood biomarkers for predicting early onset neonatal sepsis. World J. Pediatr.2012; 8(2): 101 – 108.
3. Anderson-Berry AL. and Ohning BL. Neonatal Sepsis. available from http://www.emidicine.com/ped/topic2630.html,2008
4. Tripathi S. and Malik G. Neonatal Sepsis: Past, Present And Future: A Review Article. Internet. J. Med. 2010; 5 (2): 45-54
5. Gerdes JS. Diagnosis and management of bacterial infections in the neonate. Pediatr Clin N Am.2004; 51: 939-959.
6. Shah BA, Padbury JF. Neonatal sepsis: an old problem with new insights. Virulence.2014; 5: 170-178.
7. Töllner U. Early diagnosis of septicemia in newborn. Clinical studies and sepsis score. Eur J Pediatr .1982;138: 331-337.
8. Altunhan H, Annagür A, Örs R. Procalcitonin measurement at 24 hours of age may be helpful in the prompt diagnosis of early-onset neonatal sepsis. Int J Infect Dis.2011; 15: 854-858.
9. Arnon S, Litmanovitz I. Diagnostic tests in neonatal sepsis, Curr Opin Infect Dis.2008; 21: 223-227.
10. Jo YH, Kim K, Lee JH, Kang C, Kim T. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med.2013; 31: 545-548.
11. Sharma CM, Agrawal RP, Sharan H, Kumar B, Sharma D. "Neonatal Sepsis": Bacteria & their Susceptibility Pattern towards Antibiotics in Neonatal Intensive Care Unit. J Clin Diagn Res.2013; 7: 2511-2513.
12. 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: 1150.
13. West B, Tabansi P. Prevalence of neonatal septicaemia in the University of Port Harcourt Teaching Hospital, Nigeria. Niger J Paed. 2014; 41(1):33–7.
14. Sharma M, Yadav A, Yadav S, Goel N, Chudhary U. Microbial profile of septicemia in children. Indian J. 2008; 5(4): 1- 5.
15. Cosar H, Yilmaz O, Temur M, Ozun OP, Bulut Y. Relationship between Early-Onset Neonatal Sepsis and Red Blood Cell Distribution Width (RDW). J Hematol Thrombo Dis.2017,5: 266.
16. Chacko, Betty & Sohi, Inderpreet. (2005). Early onset neonatal sepsis. Indian journal of pediatrics. 72. 23-6. 10.1007/BF02760574.
17. Medhat A Saleh, Yasser T Kasem, Hesham H Amin. Evaluation of neonatal sepsis and assessment of its severity by Red Cell Distribution Width indicator. The Egyptian Journal of Community Medicine. 2017 july; 35(3):21-32
18. Jianping Chen1, Ling Jin1, Tong Yang. Clinical study of RDW and prognosis in sepsis new borns, Biomedical Research 2015; 25 (4): 576-579
19. Abdullah ST, Moustafa AN, Mohsen Anwar A. Prognostic Validity of Red Cell Distribution Width in Neonatal Sepsis. Int J Pediatr 2018; 6(11): 8579-86. DOI: 10.22038/ijp.2018.33010.2917
20. Kim CH, Park JT, Kim EJ, Han JH, Han JS. An increase in red blood cell distribution width from baseline predicts mortality in patients with severe sepsis or septic shock. Crit Care.2013; 17: R282.
21. Jo YH, Kim K, Lee JH, Kang C, Kim T, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med.2013; 31: 545-548.
22. Robert D. Christensen, Hassan M. Yaish, Erick Henry & Sterling T. Bennett (2015) Red blood cell distribution width: reference intervals for neonates, The Journal of Maternal-Fetal & Neonatal Medicine, 28:8, 883-888, DOI: 10.3109/14767058.2014.938044
23. Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med.2009; 133: 628-632.

Dr Ajeet Singh Choudhary

Junior Resident, Dept of Internal Medicine, S.M.S Medical College, Jaipur, India