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Neonatal Sepsis Occurs With Normal CBC

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Babies can develop Early Onset Sepsis (EOS) immediately after birth, yet Complete Blood Cell Count test results (CBC) can remain normal. Although certain abnormalities in CBC  were very specific for EOS, many babies had EOS with bacteremia and a normal CBC. A normal CBC cannot rule out EOS and clinical suspicion must be relied upon in order to start antibiotic treatment early and prevent serious injuries to the baby. Unfortunately, only 2,164 (1%) out of 166,092 babies with clinically suspected EOS actually had bacteria in the bloodstream, urine or cerebrospinal fluid. This study shows that doctors cannot rely on the CBC to diagnose babies with EOS, because a normal blood count does not rule it out. This means that a large number of babies still need to be treated empirically with antibiotics when there is suspicion of sepsis, even though most of them will not have bacteremia. A normal blood test is not a reason to withhold antibiotics if there are worrisome clinical signs.

Neonatal sepsis is caused when a bacterial infection spreads throughout the body. Depending on the specific bacteria and other factors, the infection can cause massive injury to the brain, kidneys, lungs and other organs. Some infections occur during the baby's passage through the birth canal, and others occur shortly after birth. If EOS goes untreated, permanent neurological injury, organ failure and death occur. Neonatologists and pediatricians must rely on clinical examination and suspicion to identify infants at risk. Unfortunately, a normal CBC can only provide false reassurance  because a significant number of babies with EOS have false negative test results.

When neonatal sepsis is not properly recognized clinically and the baby's treatment is delayed, the effects of such malpractice can be devastating. A baby who suffers intracranial infection often ends up with lifelong mental and physical problems. The emotional and financial damage to the family is great and, even when compensation is obtainable to help cope with the negligently caused injury, these families face a difficult and uncertain future.

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