EVALUATION OF THE EXTENDED SICK NEONATAL SCORE AND ITS CORRELATION WITH BLOOD CULTURE IN NEONATES WITH SUSPECTED EARLY-ONSET SEPSIS IN A TERTIARY HEALTH CARE CENTRE- A CROSS-SECTIONAL STUDY

Abstract

Background: Neonatal sepsis remains a major contributor to neonatal morbidity and mortality worldwide, particularly in low- and middle-income countries. Early-onset sepsis (EOS), occurring within the first 72 hours of life, poses significant diagnostic challenges due to its nonspecific clinical presentation, often necessitating empirical antibiotic therapy. Although blood culture is the gold standard, its limited sensitivity and delayed results restrict timely decision-making. Conventional biomarkers like C-reactive protein (CRP), procalcitonin, total leukocyte count (TLC) lack consistent diagnostic accuracy. The Extended Sick Neonatal Score (ESNS), a validated clinical scoring system, has been proposed for assessing illness severity and predicting mortality in neonates. Objective: To evaluate the Extended Sick Neonatal Score and Its Correlation with Blood Culture in Neonates with Suspected Early-Onset Sepsis in a Tertiary Health Care Centre Methods: Study included 80 neonates meeting predefined inclusion criteria after obtaining parental consent. Maternal and neonatal demographic data were recorded. ESNS was assessed at 48 and 72 hours of life , correlated with blood culture, complete blood count, CRP, procalcitonin, urinary, serum sTREM-1 levels as per NICU protocols. Results: Urinary sTREM-1 demonstrated a moderate positive correlation with procalcitonin at 48 hours (r = 0.41, p < 0.001), which reversed to a moderate negative correlation at 72 hours (r = −0.41, p < 0.001). No significant correlation was observed between urinary sTREM-1 and TLC, serum sTREM-1, or ESNS at either time point (p > 0.05). ESNS scores at 48 and 72 hours did not differ significantly between culture-positive and culture-negative groups (p > 0.05). While no association was found between ESNS and CRP at 48 hours (p = 0.593), a significant association emerged at 72 hours (p = 0.035). Conclusion: ESNS has limited utility as a standalone tool for diagnosing culture-positive EOS. However, it may be valuable in assessing disease progression and inflammatory status, particularly when used in conjunction with biomarkers such as CRP.