Diagnostic Significance of the Delta Neutrophil Index and Other Conventional Parameters in Neonatal Bacteremia

Il Doo Koh; Ihn Soo Jeon; Hwang Min Kim

doi:10.14776/piv.2017.24.1.1

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Koh, Jeon, and Kim: Diagnostic Significance of the Delta Neutrophil Index and Other Conventional Parameters in Neonatal Bacteremia

Original Article

Pediatric Infection & Vaccine 2017; 24(1): 1-6.

Published online: 18 April 2017

DOI: https://doi.org/10.14776/piv.2017.24.1.1

Diagnostic Significance of the Delta Neutrophil Index and Other Conventional Parameters in Neonatal Bacteremia

Il Doo Koh, Ihn Soo Jeon, Hwang Min Kim

Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, the Republic of Korea.

Corresponding author (khm9120@yonsei.ac.kr)

Received 16 June 2016 Revised 22 August 2016 Accepted 15 October 2016

Abstract

Purpose

We investigated the effectiveness of the delta neutrophil index (DNI) for the prediction of neonatal bacteremia and compared it to other indices.

Methods

A total of 146 pediatric patients, aged less than 31 days, admitted to the neonatal intensive care unit of Wonju Severance Christian Hospital with fever before or during hospitalization were enrolled in this study. We divided the patients into two groups based on the existence of neonatal bacteremia and performed blood culture tests on both groups. We examined white blood cell count, absolute neutrophil count, DNI, platelet count, and C-reactive protein (CRP) test. We used a receiver operating characteristic (ROC) curve to evaluate their diagnostic significance.

Results

Seventy-seven patients were diagnosed with neonatal bacteremia. The mean gestational age was 38.74 weeks and the mean birth weight was 3.20 kg. The mean gestational age of the control group was 33.34 weeks and the mean birth weight was 2.20 kg. Causative organisms of bacteremia included Staphylococcus aureus (n=22), Staphylococcus epidermidis (n=18), and Streptococcus agalactiae (n=8). Both DNI and CRP were significantly associated with neonatal bacteremia after adjusting for gestational age and birth weight. The area under the ROC curve (AUC) for DNI (0.70) was higher than that for CRP (0.68).

Conclusions

The DNI can be used to effectively predict neonatal bacteremia. The prediction will be more accurate if DNI is used in conjunction with other indices. In future, it will be useful to compare DNI with other indices and investigate its relationship with prognosis.

Keywords: Delta neutrophil index, Neonatal bacteremia

Figures and Tables

Fig. 1

Receiver operating characteristic (ROC) curves of delta neutrophil index and other conventional parameters predicting neonatal bacteremia. The irregular form of the curve is due to the smaller sample size in the validation dataset. Abbreviations: DNI, delta neutrophil index; CRP, C-reactive protein.

Table 1

Clinical Characteristics of Study Population

Values are presented as mean±standard deviation.

Abbreviations: GA, gestational age; C-sec, cesarean section; SVD, spontaneous vaginal delivery.

Table 2

Comparison of Delta Neutrophil Index and Other Parameters between Bacteremia and Non-bacteremia Group

Values are presented as mean±standard deviation.

Abbreviations: WBC, white blood cell count; ANC, absolute neutrophil count; PLT, platelet count; DNI, delta neutrophil index; CRP, C-reactive protein.

Table 3

Multivariate Logistic Regression of Delta Neutrophil Index and Other Parameters between Bacteremia and Non-bacteremia Group

^*Crude odds ratio of each laboratory marker for bacteremia.

^†Odds ratio adjusted by gestational age and birth weight.

Abbreviations: CI, confidence interval; WBC, white blood cell count; ANC, absolute neutrophil count; PLT, platelet count; DNI, delta neutrophil index; CRP, C-reactive protein.

Table 4

Diagnostic Performance of Delta Neutrophil Index and Other Conventional Parameters

Abbreviations: PPV, positive predictive value; NPV, negative predictive value; WBC, white blood cell count; ANC, absolute neutrophil count; PLT, platelet count; DNI, delta neutrophil index; CRP, C-reactive protein.

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