Utility of Red Cell Distribution Width (RDW) In Diagnosis and Prognosis of Early-Onset Neonatal Sepsis in Term Neonates

Sandeep Golhar, Abhishek Madhura, Urmila Chauhan, Abinash Nayak


Objective: To assess the increased Red Cell Distribution Width (RDW) in diagnosis and prognosis of early-onset neonatal sepsis in term neonates. Methods: In a prospective, observational study, we enrolled term neonates ( 37 weeks of gestation) clinically suspected for Early-Onset Neonatal Sepsis (EONS) (within 7 days of birth). A cut-off of 18% and above was taken to consider RDW as abnormal or increased. The primary outcome was to assess the relation of increased RDW with in-hospital mortality. The secondary outcome was to determine the diagnostic yield of increased RDW in culture-proven sepsis. Results: In 166 neonates, 60% were males. Increased RDW was seen in 42.42% of neonates and 15.75% of neonates had positive blood culture. Compared to normal RDW, in-hospital mortality was significantly higher in neonates with increased mortality (27.14% vs. 10.52%, respectively; p=0.006). Also, abnormal RDW was seen in 46.15% of neonates with positive blood culture compared to 35.25% of neonates with negative blood culture (p<0.0001). Thus, elevated RDW had a sensitivity of 44.4% and specificity of 57.97% in the diagnosis of EONS. Conclusion: Increased RDW can be a diagnostic as well as a prognostic marker in neonates with EONS. Such observation indicates it may serve as a simple and easily available marker for EONS in resource-limited settings. However, these findings need to be confirmed in a larger sample.


Doi: 10.28991/SciMedJ-2021-0303-7

Full Text: PDF


Red Cell Distribution Width; Early-Onset Neonatal Sepsis; Mortality; Blood Culture; NICU.


World Health Organization (WHO). Newborns : improving survival and well-being. 2020 September. Available online: https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality. (accessed on May 2021).

Worldbank. UNICEF, WHO, World Bank, UN DESA Population Division. Mortality rate, under-5 (per 1,000 live births). Available online: https://data.worldbank.org/indicator/SH.DYN.MORT. (accessed on April 2021).

Sankar, M. J., Neogi, S. B., Sharma, J., Chauhan, M., Srivastava, R., Prabhakar, P. K., Khera, A., Kumar, R., Zodpey, S., & Paul, V. K. (2016). State of newborn health in India. Journal of perinatology. 36(s3), S3–S8. doi:10.1038/jp.2016.183.

Basha, S., Surendran, N., & Pichichero, M. (2014). Immune responses in neonates. Expert Review of Clinical Immunology, 10(9), 1171–1184. doi:10.1586/1744666x.2014.942288.

UNICEF. Newborn and child health. Available online: https://www.unicef.org/india/what-we-do/newborn-and-child-health. (accessed on April 2021).

Jehan, I., Harris, H., Salat, S., Zeb, A., Mobeen, N., Pasha, O., McClure, E. M., Moore, J., Wright, L. L., & Goldenberg, R. L. (2009). Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Bulletin of the World Health Organization, 87(2), 130–138. doi:10.2471/blt.08.050963.

Oza, S., Lawn, J. E., Hogan, D. R., Mathers, C., & Cousens, S. N. (2014). Neonatal cause-of-death estimates for the early and late neonatal periods for 194 countries: 2000–2013. Bulletin of the World Health Organization, 93(1), 19–28. doi:10.2471/blt.14.139790.

Murthy, S., Godinho, M. A., Guddattu, V., Lewis, L. E. S., & Nair, N. S. (2019). Risk factors of neonatal sepsis in India: A systematic review and meta-analysis. PLOS ONE, 14(4), e0215683. doi:10.1371/journal.pone.0215683.

Zea-Vera, A., & Ochoa, T. J. (2015). Challenges in the diagnosis and management of neonatal sepsis. Journal of Tropical Pediatrics, 61(1), 1–13. doi:10.1093/tropej/fmu079.

Meem, M., Modak, J. K., Mortuza, R., Morshed, M., Islam, M. S., &Saha, S. K. (2011). Biomarkers for diagnosis of neonatal infections: A systematic analysis of their potential as a point-of-care diagnostics. Journal of global health, 1(2), 201–209.

Jo, Y. H., Kim, K., Lee, J. H., Kang, C., Kim, T., Park, H. M., Kang, K. W., Kim, J., & Rhee, J. E. (2013). Red cell distribution width is a prognostic factor in severe sepsis and septic shock. The American journal of emergency medicine, 31(3), 545–548. doi:10.1016/j.ajem.2012.10.017.

Lippi, G., Targher, G., Montagnana, M., Salvagno, G. L., Zoppini, G., & Guidi, G. C. (2008). Relationship between red blood cell distribution width and kidney function tests in a large cohort of unselected outpatients. Scandinavian Journal of Clinical and Laboratory Investigation, 68(8), 745–748. doi:10.1080/00365510802213550.

Ellahony, D. M., El-Mekkawy, M. S., & Farag, M. M. (2017). A Study of Red Cell Distribution Width in Neonatal Sepsis. Pediatric Emergency Care, Publish Ahead of Print. doi:10.1097/pec.0000000000001319.

Deka, A., & P., A. (2020). Red cell distribution width as a diagnostic marker in neonatal sepsis. International Journal of Contemporary Pediatrics, 7(4), 820. doi:10.18203/2349-3291.ijcp20201137.

Chen, J., Jin, L., & Yang, T. (2014). Clinical study of RDW and prognosis in sepsis new borns. Biomedical Research, 25 (4), 576-579.

Garofoli, F., Ciardelli, L., Mazzucchelli, I., Borghesi, A., Angelini, M., Bollani, L., … Stronati, M. (2013). The red cell distribution width (RDW): Value and role in preterm, IUGR (intrauterine growth restricted), full-term infants. Hematology, 19(6), 365–369. doi:10.1179/1607845413y.0000000141.

Tonbul, A., Tayman, C., Catal, F., Kara, S., & Tatli, M. M. (2011). Red cell distribution width (RDW) in the newborn: normative data. Journal of Clinical Laboratory Analysis, 25(6), 422–425. doi:10.1002/jcla.20496.

Sankar, M. J., Agarwal, R., Deorari, A. K., & Paul, V. K. (2008). Sepsis in the Newborn. The Indian Journal of Pediatrics, 75(3), 261–266. doi:10.1007/s12098-008-0056-z.

Martin, S. L., Desai, S., Nanavati, R., Colah, R. B., Ghosh, K., & Mukherjee, M. B. (2018). Red cell distribution width and its association with mortality in neonatal sepsis. The Journal of Maternal-Fetal & Neonatal Medicine, 32(12), 1925–1930. doi:10.1080/14767058.2017.1421932.

Omer, I., & Mohammed, B. (2021). A study of red cell distribution width and neonatal sepsis at Soba University Hospital, Khartoum, Sudan. Sudanese Journal of Paediatrics, 42–47. doi:10.24911/sjp.106-1597237251.

Christensen, R. D., Yaish, H. M., Henry, E., & Bennett, S. T. (2014). Red blood cell distribution width: reference intervals for neonates. The Journal of Maternal-Fetal & Neonatal Medicine, 28(8), 883–888. doi:10.3109/14767058.2014.938044.

Mondal, G. P., Raghavan, M., Bhat, B. V., & Srinivasan, S. (1991). Neonatal septicaemia among inborn and outborn babies in a referral hospital. The Indian Journal of Pediatrics, 58(4), 529–533. doi:10.1007/bf02750936.

Jajoo, M., Kapoor, K., Garg, L., Manchanda, V., & Mittal, S. (2015). To study the incidence and risk factors of early onset neonatal sepsis in an out born neonatal intensive care unit of India. Journal of Clinical Neonatology, 4(2), 91. doi:10.4103/2249-4847.154106.

Bhongade, S., Meshram, R., & Gajimwar, V. (2019). Predictors of mortality in outborns with neonatal sepsis: A prospective observational study. Nigerian Postgraduate Medical Journal, 26(4), 216-222. doi:10.4103/npmj.npmj_91_19.

Mousa, S., Moustafa, A., & Aly, H. (2019). Prognostic value of red cell distribution width, platelet parameters, and the hematological scoring system in neonatal sepsis. The Egyptian Journal of Haematology, 44(3), 183. doi:10.4103/ejh.ejh_12_19.

Karabulut, B., & Arcagok, B. C. (2019). New Diagnostic Possibilities for Early Onset Neonatal Sepsis: Red Cell Distribution Width to Platelet Ratio. Fetal and Pediatric Pathology, 39(4), 297–306. doi:10.1080/15513815.2019.1661051.

Full Text: PDF

DOI: 10.28991/SciMedJ-2021-0303-7


  • There are currently no refbacks.

Copyright (c) 2021 Urmila Chauhan