Role of Gastric Aspirate Polymorphs in Diagnosis of Early Onset Neonatal Sepsis

Introduction: Neonatal sepsis is one of the major causes of morbidity and mortality in the newborn. Early diagnosis of neonatal septicemia is the cornerstone for the successful management and favorable outcome. It is a challenge because of non-specific symptoms and signs of neonatal sepsis. Gastric aspirate cytology has been used for the diagnosis of neonatal infection. The presence of more than five polymorphs per high power field co-relate with neonatal infection. Objective To study correlation between positive gastric aspirate and development of early onset neonatal sepsis. Methods This is a Prospective Hospital based cross sectional Study conducted at Neonatal Intensive Care Unit (NICU) of Department of Pediatrics, Manipal Teaching Hospital, Pokhara, Nepal from November 2017 to May 2019. A total of 96 cases who were admitted in NICU suspected with EONS were included in the study. Under all aseptic conditions, nasogastric tube was inserted and gastric fluid was collected and sent to the pathology department. All slides were stained with Leishman’s stain and then examined for the presence of neutrophils under light microscope. Results Out of 96 neonates, 24 were blood culture positive and 72 were culture negative. Gastric aspirate examination was positive in 61 patients and negative in 35 patients. Gastric aspirate is more positive in term and normal birth weight babies. Among 61 gastric aspirate positive cases 21 are blood culture positive and 40 are culture negative (p = 0.005). Among other acute phase reactant, gastric aspirate has highest sensitivity (87.5%). Conclusions The present study concludes that gastric aspirate polymorphs are good screening tool in the early detection of early neonatal sepsis in a resource limited settings.