2%) had LBW and a fair number of them were preterm (14/38; 36.8%). Ng et al. used CRP, cytokines, and adhesion molecule to identify late-onset neonatal sepsis (LONS) in preterm infants with very low birth weight.[9] They found that IL-6 had the highest sensitivity (89%) choose size and negative predictive value (91%) for detecting infection on day 0. However, between 24 hours and 48 hours of onset CRP was the best single marker. In another study it was found that IL-6 combined with PCT values was a fair way to evaluate EONS, and also that I/T ratio was as efficient as IL-6.[10] Walliullah et al. found the sensitivity and specificity of m-ESR to be 63.3% and 60%, respectively, and that of I/T ratio to be 70% and 56%, respectively, in neonatal sepsis.

[11] They also found that a combination of m-ESR and I/T ratio showed high sensitivity (80%) and specificity (70%). However, in the present study, a combination of m-ESR and I/T ratio showed low sensitivity (31%) and high specificity (95%). Several other authors have studied CRP and hematological parameters in neonatal sepsis.[12�C14] Most of them found that CRP especially in combination with other tests were very helpful to diagnose neonatal sepsis. During the first 3 days of life CRP, leucopenia, and neutropenia were reported to be comparatively good tests, while after 3 days of life CRP was the best single test for detecting EONS.[15,16] In our study, CRP was the most sensitive test (84%), though with a relatively low specificity of 65%. However, when CRP was combined with I/T ratio, the specificity increased to 95%.

Combination of CRP with other tests also gave good results. CRP can be used to differentiate between positive and contaminated blood culture in children and has been shown to be a better predictor than white blood count (WBC) or absolute neutrophil count (ANC) for this purpose.[15] Morphological changes in neutrophils showed high sensitivity (68%) and specificity (80%) in our study, but other authors have found relatively lower sensitivity (44%) and higher specificity (94%).[13] Some authors formulated a hematological scoring system (HSS) to diagnose EONS;[10,12] a hematological score of ��3 had sensitivity of 86% and a negative predictive value of 96%.[14] Hematological tests like Hb level, total leukocyte count, differential leukocyte count, and platelet count, when combined with the four important tests mentioned earlier, have been found to be very useful to diagnose neonatal sepsis.

[11,17,18] In our study, 27 of the 38 proven cases (69.1%) had low Hb. Many of them (n=18) had unconjugated hyperbilirubinemia that was not due to ABO or Rh incompatibility. In these cases, the low Hb level could have Carfilzomib been due to increased hemolysis of red blood cells caused by bacterial infection in blood. The first immunoglobulin produced by neonates is IgM and increased level of this antibody is found in acute bacterial, viral, and parasitic infections.