{"doi":"10.1093/trstmh/traa023","title":"Feasibility of manual white blood cell counts as a predictor of neonatal sepsis in a low-resource setting","abstract":"BACKGROUND: Manual white blood cell (WBC) differential counts as a predictor for neonatal sepsis development in a low-resource setting have not been thoroughly evaluated. We hypothesized that manual differentiation (specifically immature:total [I:T] neutrophil ratios) would be feasible and useful as an adjunct to predict early-onset neonatal sepsis (EONS). Secondarily, we hypothesized that vaccination with bacillus Calmette-Guérin (BCG) and oral polio vaccine (OPV) could alter WBC differential counts and thus might reduce its predictive performance. METHODS: We performed a prospective cohort study within a randomized trial, randomizing healthy, high-risk newborns admitted to the nursery at the national hospital in Guinea-Bissau 1:1 to BCG+OPV at admission or at discharge (usual practice). Thin capillary blood films were prepared at 2 d of age in a subset of 268 neonates. WBC counts were assessed by microscopy and neonates were followed up for sepsis development within 2 weeks. RESULTS: Ninety-eight percent (264/268) of smears provided interpretable reads. Of the 264 children, 136 had been randomized to receive BCG+OPV prior to sampling; the remaining 128 were vaccinated at discharge. The I:T ratio (average 0.017) was lower among children who did not develop clinical sepsis but did not predict sepsis (p=0.70). Only three children had an I:T ratio >0.2 (associated with a higher probability of clinical sepsis in previous studies) but did not develop sepsis. Immunization did not alter WBC composition. CONCLUSIONS: Manual WBC differentials are feasible in low-resource settings. WBC differentials are not affected by standard newborn immunization. However, the I:T ratio had no value in predicting subsequent development of sepsis.","journal":"Transactions of the Royal Society of Tropical Medicine and Hygiene","year":2020,"id":107213,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9657,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":266194,"name":"Frederik Schaltz‐Buchholzer","orcid":"0000-0001-7643-8322","position":1,"is_corresponding":false},{"id":266195,"name":"Lilica Sanca","orcid":"0000-0002-1787-2396","position":2,"is_corresponding":false},{"id":516865,"name":"Clara Clipet-Jensen","orcid":null,"position":3,"is_corresponding":false},{"id":104388,"name":"Christine Stabell Benn","orcid":"0000-0001-6102-3810","position":4,"is_corresponding":false},{"id":516074,"name":"Nicholas Au","orcid":"0000-0003-4009-3048","position":5,"is_corresponding":false},{"id":516075,"name":"Kate Chipperfield","orcid":"0000-0003-3607-1508","position":6,"is_corresponding":false},{"id":258306,"name":"Tobias R. Kollmann","orcid":"0000-0003-2403-9762","position":7,"is_corresponding":false},{"id":266202,"name":"Nelly Amenyogbe","orcid":"0000-0002-7817-1534","position":8,"is_corresponding":false},{"id":266196,"name":"Christian N Golding","orcid":"0000-0002-5950-8859","position":0,"is_corresponding":true}],"reference_count":33,"raw_metadata":null,"created_at":"2026-07-18T23:12:34.898963Z","pmid":"32333010","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}