Register      Login

VOLUME 1 , ISSUE 2 ( April-June, 2022 ) > List of Articles


Automated Cell Counter-derived Neutrophil Cell Population Data by VCS Technology as a Marker of Early-onset Neonatal Sepsis

Francesco Morotti, Gilberto F Candela, Giovanni Martellosio, Federico Serana, Moira Micheletti, Duilio Brugnoni, Francesco M Risso

Keywords : Automated cell counter, Case-control study, Cell population data, Diagnosis, Early-onset neonatal sepsis, Markers, Neutrophils

Citation Information : Morotti F, Candela GF, Martellosio G, Serana F, Micheletti M, Brugnoni D, Risso FM. Automated Cell Counter-derived Neutrophil Cell Population Data by VCS Technology as a Marker of Early-onset Neonatal Sepsis. 2022; 1 (2):209-214.

DOI: 10.5005/jp-journals-11002-0030

License: CC BY-NC 4.0

Published Online: 05-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: Early-onset neonatal sepsis (EONS) occurring within the first 72 hours after birth is a common, life-threatening disease in neonatal intensive care units (NICUs). The limited accuracy of diagnostic tools makes the diagnosis of EONS difficult, and the quest for new markers remains open. Automated hematology analyzer-derived neutrophil cell population data (N-CPD) have been identified as a potential marker of neonatal sepsis, but their role for EONS has not been elucidated yet. Our aim is to explore the role of automated hematology analyzer-derived N-CPD as a marker of EONS. Methods: We prospectively evaluated a cohort of 289 neonates admitted to the NICU with clinical signs of sepsis, and checked if N-CPD from the Beckman Coulter UniCel DxH 800 device could help identify those who would develop culture-proven EONS. Clinical characteristics, sepsis markers, blood culture results, and N-CPD were recorded. The diagnostic accuracy of N-CPD was tested using receiver-operator curves (ROCs). Results: Receiver-operator curves of the standard deviation of neutrophil volume (SD-V) showed moderate accuracy in identifying EONS (AUC 0.74), with a high negative predictive value (NPV 98.6%) for cut-off values >21.76 arbitrary units. Accuracy was higher with VCS at 12–48 hours of life (AUC 0.8). Standard deviation of neutrophil volume accuracy was independent from gestational age (GA), birth weight, and timing of test execution (OR 1.14, p = 0.002; AUC 0.71). Conclusion and significance: Our study confirms the role of N-VCS in the diagnostic workup for EONS. High NPV values may be useful as they suggest a role as an adjunctive marker useful for ruling-out EONS and support early empirical antibiotic withdrawal.

  1. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet 2017;390(10104):1770–1780. DOI: 10.1016/S0140-6736(17)31002-4.
  2. Van Den Hoogen A, Gerards LJ, Verboon-Maciolek MA, et al. Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents. Neonatology 2009;97(1):22–28. Available from:
  3. Weston EJ, Pondo T, Lewis MM, et al. The burden of invasive early-onset neonatal sepsis in the united states, 2005–2008. Pediatr Infect Dis J 2011;30(11):937–941. Available from:
  4. Newman TB, Draper D, Puopolo KM, et al. Combining immature and total neutrophil counts to predict early onset sepsis in term and late preterm newborns: use of the I/T2. Pediatr Infect Dis J 2014;33(8):798–802. Available from:
  5. Schmutz N, Henry E, Jopling J, et al. Expected ranges for blood neutrophil concentrations of neonates: the Manroe and Mouzinho charts revisited. J Perinatol 2008;28(4):275–281. Available from:
  6. Hornik CP, Becker KC, Benjamin DK, et al. Use of the complete blood cell count in late-onset neonatal sepsis. Pediatr Infect Dis J 2012;31(8):803–807. DOI: 10.1097/INF.0b013e31825691e4.
  7. Krause JR. Automated differentials in the hematology laboratory. Am J Clin Pathol 1990;93(4 Suppl 1):S11–S16. PMID: 2180276.
  8. Xu D. Clinical applications of leukocyte morphological parameters. Parameters Int J Pathol Clin Res 2015;1:1. DOI: 10.23937/2469-5807/1510002.
  9. Raimondi F, Ferrara T, Capasso L, et al. Automated determination of neutrophil volume as screening test for late-onset sepsis in very low birth infants. Pediatr Infect Dis J 2010;29(3):288. Available from:
  10. Bhargava M, Saluja S, Sindhuri U, et al. Elevated mean neutrophil volume+CRP is a highly sensitive and specific predictor of neonatal sepsis. Int J Lab Hematol 2014;36(1):e11–e14. Available from:
  11. Celik IH, Demirel G, Aksoy HT, et al. Automated determination of neutrophil VCS parameters in diagnosis and treatment efficacy of neonatal sepsis. Pediatr Res 2012;71(1):121–125. DOI: 10.1038/pr.2011.16.
  12. Çelik HT, Portakal O, Yiʇit Ş, et al. Efficacy of new leukocyte parameters versus serum C-reactive protein, procalcitonin, and interleukin-6 in the diagnosis of neonatal sepsis. Pediatr Int 2016;58(2):119–125. Available from:
  13. Abiramalatha T, Santhanam S, Mammen JJ, et al. Utility of neutrophil volume conductivity scatter (VCS) parameter changes as sepsis screen in neonates. J Perinatol 2016;36(9):733–738. DOI: 10.1038/jp.2016.69.
  14. Nesargi P, Niranjan HS, Bandiya P, et al. Neutrophil Volume, conductivity and scatter (VCS) as a screening tool in neonatal sepsis. Sci Rep 2020;10(1):4457. DOI: 10.1038/s41598-020-61434-z.
  15. Jean A, Boutet C, Lenormand B, et al. The new haematology analyzer DxH 800: An evaluation of the analytical performances and leucocyte flags, comparison with the LH 755. Int J Lab Hematol 2011;33(2):138–145. Available from:
  16. Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biometrical J 2005;47(4):458–472. Available from:
  17. Swets JA. Measuring the accuracy of diagnostic systems. Sci 1988;240(4857):1285–1293. Available from:
  18. Hincu M-A, Zonda G-I, Stanciu GD, et al. Relevance of biomarkers currently in use or research for practical diagnosis approach of neonatal early-onset sepsis. Children 2020;7(12):309. Available from:
  19. Puopolo KM, Lynfield R, Cummings JJ, et al. American Academy of Pediatrics, Committee on Fetus and Newborn, Committee on Infectious Diseases. Management of infants at risk for group B streptococcal disease. Pediatrics 2019;144(2):e20191881. Available from:
  20. Berardi A, Bedetti L, Spada C, et al. Serial clinical observation for management of newborns at risk of early-onset sepsis. Curr Opin Pediatr 2020;32(2):245–251. Available from:
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.