Background: Early diagnosis of sepsis is a clinical challenge as the clinical symptoms are subtle, late, and nonspecific. Minimum of 48 hours is required for the earliest result of blood culture, and it can be negative despite clinical signs of sepsis. Delaying the treatment leads to an increase in mortality. Thus, it is crucial to diagnose neonatal sepsis early to initiate treatment as early as possible.
Aims:  To assess the pattern of systemic peripheral inflammatory response markers as early predictors for the diagnosis of sepsis in neonates.
Patients and methods: This was a case-control study conducted on one hundred cases suspected to have with neonatal sepsis (NS), in addition to other fifty neonates with no suspicion of having NS. All the subjects underwent thorough history taking, complete clinical evaluations, and laboratory investigations for a systemic inflammatory response.
Results: The overall patients' mean ages were (14.12 ±7.12 days), 70% were male and 30% were females. When compared to the control group we found elevated immature to total neutrophil (IT) ratio, CRP, ESR, TLC, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) to have significant diagnostic value for NS, in addition to hematological indices and scores.
Conclusion: The IT ratio is the best single index for NS diagnosis having a comparable significance as CRP and ESR, however, the IT ratio was superior to WBC count in the sensitivity, specificity, the positive predictive value, and the negative predictive value.