Abstract / Summary
Background: Clinical manifestations of neonatal sepsis are non-specific, and no single biomarker consistently diagnoses all cases. The neutrophil-to-lymphocyte count ratio (NLCR) is an accessible marker in adults, but its diagnostic efficacy in neonates remains understudied. Aims and Objectives: The aim of this study was to compare the diagnostic performance of NLCR and C-reactive protein (CRP) at 0 and 72 h in predicting neonatal sepsis. Materials and Methods: This cross-sectional analytical study (January–June 2026) evaluated 263 neonates selected through convenience sampling at Birat Medical College Teaching Hospital. Blood cultures, CRP (positive ≥10 mg/dL), and NLCR (cutoff >2.2) were analyzed. Subjects were categorized into culture-confirmed and culture-negative suspected sepsis groups. Diagnostic metrics were evaluated using Chi-square tests and Statistical Package for the Social Sciences v23. Results: Of 263 neonates (60.8% female; median age: 2 days), CRP at 72 h demonstrated the highest sensitivity (71.3%), negative predictive value (87.2%), and overall accuracy (81.0%), with 85.2% specificity. CRP at 0 h showed excellent specificity (92.3%) but poor sensitivity (25.0%). The NLCR category yielded low sensitivity (32.5%), 72.7% specificity, 34.2% positive predictive value, and 60.5% accuracy. Conclusion: CRP at 72 h is the most reliable screening tool for neonatal sepsis due to its superior sensitivity and accuracy. CRP at 0 h serves as an effective confirmatory test given its high specificity, whereas NLCR is not recommended as a standalone predictor.