J Lab Med Qual Assur.  2003 Dec;25(2):237-242.

The Use of Immatane to Total Neutrophil (IT) Ratio to Detect Bacteriemia in Neonatal Sepsis

• Aulia D
• Sanjaya AI
• Timan IS

Abstract

BACKGROUND: Infection is still a major problem in developing countries, including Indonesia. The incidence of neonatal infection in some referral hospital in Indonesia is quite high, between 8.76-30.29%, with a mortality rate of 11.56-49.9%. The early detection of neonatal sepsis is very important for the management of the patients, but many rural health centers do not have the required laboratory facilities available to diagnose it. The ratio of immature neutrophyl to total neutrophyl (IT ratio) is a simple test, requiring no sophisticated equipment, and can be done in a minimal laboratory setting to be used as a screening test to detect infection. In infection or sepsis a shift to the left of the neutrophil in the peripheral blood smear could be observed. An IT ratio of >0.2 and leukopenia is a marker for detecting neonatal infection. The aim of this study is to obtain the reference value of IT ratio in healthy newborn children and to know the IT ratio in neonatal sepsis and the difference of IT ratio of between capillary and K3EDTA blood. Blood smears were also made hourly with K3EDTA blood kept for 6 hours to observe any changes.
METHODS
Materials were obtained from 70 healthy and 41 septic newborns. Capillary blood smear and K3EDTA blood smear were prepared using May-Grunwald-Giemsa staining, and a differential counts were performed manually using a binocular microscope.
RESULTS
Reference IT Ratio in healthy newborns was 0.01-0.13 (mean 0.06), in septic newborns 0.13-0.60 (mean 0.26) and the cut off value for sepsis detection was 0.13. There were no difference in the IT ratio between direct capillary blood or K3EDTA blood smear. Samples could be kept until 6 hour without any deterioration.
CONCLUSION
The reference value of IT ratio in healthy newborns were 0.01-0.13 (mean 0.06), in sepsis neonatus 0.13-0.60 (median 0.26) and the cut off value for sepsis detection was 0.13. IT ratio could be used as a marker for early detection of newborn septicemia.

MeSH Terms

Capillaries
Child
Developing Countries
Humans
Incidence
Indonesia
Infant, Newborn
Leukopenia
Mass Screening
Mortality
Neutrophils*
Reference Values
Referral and Consultation
Rural Health Services
Sepsis*
Telescopes