14, 15, 16 and 17 Some authors consider that certain factors complicate the diagnosis of sepsis in the neonatal period, due to the nonspecific clinical signs, which may be mistaken as some characteristic conditions of the period, such as transient tachypnea and

apnea of prematurity. Clinical abnormalities in newborns are considered as having low predictive value for sepsis, and other parameters are necessary for the confirmation of infection. Therefore, the diagnosis of neonatal sepsis is considered difficult from both the clinical and laboratory perspective. Moreover, negative blood culture results do not imply in the absence of sepsis in the neonate, as this test has low sensitivity.16 and 17 Some studies have shown the variability and low predictive value of clinical INCB024360 in vitro signs of infection in neonates. A Brazilian study conducted in a NICU, which followed 55 neonates with suspected infection, demonstrated that clinical signs of neonatal sepsis may vary, with manifestations such as hypothermia and hyperthermia (33%), tachycardia (11%), and hypoactivity (94%).18 Another study, which analyzed 220 episodes of clinical sepsis in a NICU in India, identified hypoactivity (46.4%), apnea (33.6%), and gastric stasis (33.6%) as the most frequent clinical signs. With the analysis of MK 2206 the clinical score for sepsis proposed in this study,

it was observed that clinical signs are reduced from the time of suspected infection up to the following 24 hours, with a sensitivity of 90% (0 h) and 75% (24 h), Phosphoglycerate kinase and low PPV of 30.3% (0 h) and 41.7% (24 h).19 This result is similar to another study performed in Bangladesh20 with analysis of clinical predictors of sepsis in premature neonates with positive cultures (n = 105), in which the application of the clinical score showed low sensitivity of 56.6%, specificity of 52.1%, and PPV of 78.1%. Another study, by Singh et al.,21 analyzed 16 clinical signs of sepsis and identified a sensitivity

of 47%, 40%, and 30% for apnea, lethargy, and tachycardia, respectively, as the best results. As signs and symptoms of sepsis in the newborn are nonspecific, it is apparent that the combination of clinical signs and laboratory abnormalities may contribute to neonatal sepsis diagnosis and notification. In 1988, Rodwell et al.22 proposed the use of the hematologic score to predict sepsis in neonates with a compatible picture, with standardized parameters for global leukocytes, total neutrophils, immature neutrophils, immature/mature neutrophil ratio, as well as platelet count and degenerative alterations. When applying the score, it was observed that 96% of neonates with proven sepsis and 100% of those with probable sepsis had scores altered by greater than three‐fold.