Table 8.1Evidence profile for diagnostic accuracy of tests based on peripheral white blood cell counts in asymptomatic babies at risk of early-onset neonatal infection

Number of studiesNumber of babiesSensitivity (95% confidence interval)Specificity (95% confidence interval)Positive likelihood ratio (95% confidence interval)Negative likelihood ratio (95% confidence interval)Quality
White blood cell count of 0–4.99 ×103/microlitre
At < 1 hour of age
1
(Newman 2010)
67,623NCNC0NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC27.6NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC80.5NCLow
White blood cell count of 5–9.99 ×103/microlitre
At < 1 hour of age
1
(Newman 2010)
67,623NCNC1.4NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC2.4NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC6.4NCLow
White blood cell count of 10–14.99 ×103/microlitre
At < 1 hour of age
1
(Newman 2010)
67,623NCNC1.1NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC0.7NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC1.0NCLow
White blood cell count of 15–19.99 ×103/microlitre
At < 1 hour of age
1
(Newman 2010)
67,623NCNC0.7NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC0.6NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC0.4NCLow
White blood cell count of ≥20 ×103/microlitre
At < 1 hour of age
1
(Newman 2010)
67,623NCNC1.2NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC0.8NCLow
At4 hours of
1
(Newman 2010)
67,623NCNC0.2NCLow
Absolute neutrophil count of 0–0.99 ×103/microlitre
At < 1 hour of age
1
(Newman 2010)
67,623NCNC7.5NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC33.5NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC115NCLow
Absolute neutrophil count of 1–1.99 ×103/microlitre
At < 1 hour of age
1
(Newman 2010)
67,623NCNC2.3NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC9.3NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC51.7NCLow
Absolute neutrophil count of 2–4.99 ×103/microlitre
At < 1 hour of age
1
(Newman 2010)
67,623NCNC1.0NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC1.1NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC6.9NCLow
Absolute neutrophil count of 5–9.99 ×103/microlitre
At < 1 hour of age
1
(Newman 2010)
67,623NCNC0.9NCLow
At 1–3.99 hours of age
1
(Newman 2010
67,623NCNC0.9NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC0.6NCLow
Absolute neutrophil count of ≥10 ×103/microlitre
At < 1 hour of age
1
(Newman 2010)
67,623NCNC0.9NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC0.6NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC0.3NCLow
Immature:total neutrophil ratio of 0–0.1499
At < 1 hour of age
1
(Newman 2010)
67,623NCNC0.4NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC0.5NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC0.3NCLow
Immature:total neutrophil ratio of 0.15–0.299
At < 1 hour of age
1
(Newman 2010)
67,623NCNC1.3NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC1.2NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC1.2NCLow
Immature:total neutrophil ratio of 0.3–0.4499
At < 1 hour of age
1
(Newman 2010)
67,623NCNC1.4NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC2.9NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC3.1NCLow
Immature:total neutrophil ratio of 0.45–0.599
At < 1 hour of age
1
(Newman 2010)
67,623NCNC4.8NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC3.3NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC8.8NCLow
Immature:total neutrophil ratio of ≥ 0.6
At < 1 hour of age
1
(Newman 2010)
67,623NCNC6.1NCLow
At 1–3.99 hours of age
1
(Newman 2010)
67,623NCNC8.4NCLow
At4 hours of age
1
(Newman 2010)
67,623NCNC10.7NCLow
Composite measure of abnormal white blood cell count (defined as any of: total white blood cell count ≤ 5,000 or ≥ 30,000/mm3; absolute neutrophil count < 1,500 mm3; or immature:mature neutrophil ratio > 0.2)
1
(Ottolini 2003)
1,65541
(18 to 65)
73
(71 to 75)
1.5
(0.9 to 2.7)
0.8
(0.5 to 1.2)
Low

NC not calculable, WBC white blood cell

See the complete GRADE Table J 8.1

From: 8, Investigations before starting antibiotics in the baby

Cover of Antibiotics for Early-Onset Neonatal Infection
Antibiotics for Early-Onset Neonatal Infection: Antibiotics for the Prevention and Treatment of Early-Onset Neonatal Infection.
NICE Clinical Guidelines, No. 149.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2012 Aug.
Copyright © 2012, National Collaborating Centre for Women’s and Children’s Health.

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