Diagnosis of Neonatal Sepsis: A Clinical and Laboratory Challenge

The evaluation of tests for neonatal sepsis is important because the infection may present a very serious threat to the baby. There is an urgent need to know whether the baby has sepsis to institute treatment as quickly as possible. Confirmation of the diagnosis may take time, and diagnostic tests are used to obtain a rapid indication of the infection status. These tests are not perfect. Some real cases of infection will produce negative test results, whereas some babies without infection will test positive. The potential usefulness of the test will depend, above all, on the clinical condition of the baby. If the baby is really very sick, the test will not give very much additional information. Similarly, if the baby is evidently well, a clinical examination will be sufficient and a positive test result would not dramatically increase the probability that the baby is infected. It is in situations in which the clinical picture leaves the physician in doubt about the infection status that a diagnostic test is likely to be most useful. Thus, the result of a diagnostic test must be evaluated in the light of the clinical condition of the baby. Extensive literature exists on single laboratory tests or combinations of tests, as well as tests used together with risk factors and/or clinical signs, to diagnose neonatal sepsis. In many instances, the results of the evaluations have been conflicting. There are several possible explanations for the divergent results, and the purpose of this review is to update readers on the topic and raise issues that should be addressed in the future. Throughout pregnancy and until the membranes rupture, the fetus is relatively protected from the microbial flora of the mother by the chorioamniotic membranes, the placenta, and poorly understood antibacterial factors in amniotic fluid (1). However, there …