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Original ArticleBreastfeeding Motivation and exclusive Breastfeeding Original Article

DOI: 103126/JNPS.V4113

Shashikant Patidar, Prabhat Singh Baghel, Naresh Bajaj

Department of Pediatrics, Shyam Shah Medical College, Hari Bhushan Nagar, Rewa, Madhya Pradesh, India 

Mean Platelet Volume as a Marker of Sepsis in Newborn

Introduction: Neonatal sepsis is the leading cause of death in developing 
country like India and we need early diagnosis and treatment to prevent mortality 
so we require better diagnostic marker for sepsis. Mean platelet volume (MPV) is 
a measure of average platelet volume which represents inflammatory burden of 
disease. In our study MPV rises in septic neonates significantly and can be helpful 
to diagnose sepsis early with other blood counts. 

Methods: This case-control study was done on 500 newborns, out of which 
452 included in study are classified into two groups that is group A (n = 226): 
apparently healthy neonates, group B (n = 226): diagnosed with neonatal sepsis 
by septic screening positive. All patients in the study were go through adequate 
valuation of their history, clinical examination, complete blood count including 
MPV, C-reactive protein (CRP) and blood culture.

Results: Septic neonates showed statistically higher values of MPV than the 
control group. The diagnostic cut-off value of MPV NS was 10.2 fl.

Conclusions: MPV which is a platelet index obtained from complete blood 
count can be used an additional marker along with established septic screen to 
ensure early diagnosis in neonatal sepsis.

Abstract

*Corresponding Author
Naresh Bajaj 
Professor and Head of Department,
Shyam Shah Medical College, 
Hari Bhushan Nagar, Rewa, 
Madhya Pradesh 486001, India 
E-mail: shashikant4953@gmail.com

Article History 
Received On : 03 Apr, 2022
Accepted On : 09 Dec, 2022

Funding sources: None

Conflict of interest: None

Keywords: Mean platelet volume; newborn; 
sepsis

Online Access

DOI:
https://doi.org/10.3126/jnps.v42i2.44272

Introduction
Neonatal sepsis is characterized by signs and symptoms of infection along with or 
without microorganism in first 28 days of life. Neonatal sepsis is a continual and 
important reason of morbidity and mortality which collectible for one fourth of neonatal 
deaths.1 Fatality due to sepsis is between 30% and 50%. The clinical signs and 
symptoms of sepsis in newborns may be subtle and hence requires a high degree of 
suspicion to diagnose it. 

There is no single laboratory test with 100% sensitivity and specificity. Blood culture 
remains to be the gold standard test to diagnose neonatal sepsis but it takes almost 
about two to eight days for the results to come, it is relatively expensive and it has a 
low positivity rate. All newborns suspected to have sepsis should go through a septic 
screen which include total leucocyte count (TLC), absolute neutrophil count (ANC), 
immature to mature neutrophil ratio (I:T ratio), micro erythrocyte sedimentation rate 
(uESR) and C-reactive protein (CRP). 

The need of the hour is to identify a test that is cheap, accurate, and easy to perform 

Copyrights & Licensing © 2022 by author(s). This is an Open Access article distribut-
ed under Creative Commons Attribution License (CC BY NC )



J Nepal Paediatr Soc | VOL 42 | ISSUE 02 |MAY-AUG,  202258

Original Article Platelet Volume as a marker of sePsis

with quick availability of reports to complement the early detection 
of sepsis in neonates as early diagnosis and treatment decreases 
the neonatal morbidity and mortality.2 The aim of the study is to 
determine any change in MPV with neonatal sepsis.

Methods
Institutional Ethical Committee of Rewa permitted for the study, 
and after taking consent from the parents of the patients this case-
control study was carried out on full-term neonates admitted in 
Gandhi Memorial Hospital, Rewa, India. During this interval from 
January 2019 to December 2019, all neonates were classified 
into two groups. Group A (n = 226): apparently healthy neonates 
and Group B (n = 226): diagnosed with neonatal sepsis by septic 
screening positive. Term neonates more than 37 weeks, with one 
or more maternal risk factors for early onset sepsis and neonates 
with history of maternal premature rupture of membrane were 
included in the study. Similarly, neonates with dimorphic features 
suggestive of chromosomal abnormalities, perinatal asphyxia 
and neonates who had already received antibiotics before arrival 
in our institute were excluded from the study. After taking consent 
from the parents, babies who were suspected to have sepsis were 
enrolled in the study. Detailed obstetric history (any previous 
abortion, still birth, sibling death, previous NICU admission), 
including antenatal history was documented. Detection of clinical 
signs of sepsis such as temperature instability, cardiorespiratory 
dysfunctions, GIT dysfunction, neurological dysfunction and renal 
dysfunction were noted. Septic screen was sent and neonates 
with ≥ 2/4 positive parameters were considered to have sepsis 
or blood culture proven sepsis. Laboratory parameter for sepsis 
were total leukocyte count < 5000 / mm³ or < 20,000 / mm³, 
u ESR < 15 mm in first hour, C reactive protein (CRP) positive, 
Absolute Neutrophil Count: As per Manroe and Mouzinhos 
chart and blood culture measurement. Four ml blood sample of 
venous blood was collected aseptically by venipuncture. Two ml 
whole blood was put in EDTA vacuum container and mixed up 
and down gently which was used to measure CBC, MPV and u 
ESR. One ml of blood was put in plain tube without anticoagulant 
for the assay of CRP. Laboratory investigations CBC was done 
for all samples using automated cell counter Mindray BC 3600. 
CRP was measured by using the CRP latex slide agglutination test 
for qualitative detection of CRP. Latex particle coated with goat 
IgG anti human CRP are agglutinated when mixed with sample 
containing CRP. The sensitivity of 0.6 ml /dl of CRP according 
to the world health organization (WHO) international reference 
preparation positive and negative controls are recommended to 
monitor the performance of the procedure, as well as comparative 
pattern for better result interpretation. Data were analyzed 
using SSPS software. Quantitative data were conveyed as 
mean ± SD and qualitative data were conveyed as frequency and 
percentage. Independent sample t-test of significance was used 
when comparing two means. The w2-test of significance was used 
to analyse proportions in between two qualitative parameters. P 
value < 0.05 was considered as significant. Receiver operator 
curve (ROC) was generated and the area under curve (AUC) was 
evaluated. Sensitivity, specificity, positive predictive value (PPV) 
and negative predictive values (NPV) were also calculated.

Results
Five hundred neonates were eligible for the study, of which 48 
neonates were excluded for various reasons. Among the two 

large groups:  Total 452 neonates divided into Group A healthy 
neonates comprised 67.6% (n = 153) males and 32.3% (n = 73) 
females while Group B septic neonates comprised 62.3% (n = 
142) males and 37.1% (n = 84). In our study, maximum neonates 
were admitted with dull / lethargic (or refusal to feed) 35% (n 
= 79), convulsion 16% (n = 36), respiratory distress (includes 
tachypnea / subcoastal retraction / intercostal retraction / grunt) 
and 11.5% (n = 26) as shown in Table no. 1 

Table No 1. Showing frequency and percentage of clinical 
characteristics 

S.No Clinical characteristics N %

1.  Lethargic / dull 79 35

2.  Convulsion 36 16

3.  Respiratory distress 26 11.5

4. Fever 25 11

5.  Cold peripheries 18 8

6. Low urine output 16 7

  7.  Skin rash 5 2

When we compared the study groups, there was significant 
difference between the two groups (septic and non septic) 
regarding the septic screening profiles. TLC, ANC, u ESR, MPV 
showed statistically significant increase in the septic group B than 
healthy group A and platelets were significantly decreased in 
the septic group B. There was no significant statistical difference 
found between septic and healthy groups among the parameters 
of hemoglobin and RBC.

Table No 2. Showing Mean ± SD and p value of case and 
controls

 PARAMETER GROUP A GROUP B t-VALUE P VALUE

Haemoglobin 9.54 ± 16.2 7.11 ± 15.45 -0.948 0.3438

RBC 0.87 ± 4.58 0.88 ± 4.44 -1.701 0.0897

WBC 3174 ± 9979 8367 ± 16761 11.393 < 0.0001

ANC 2535 ± 5585 6143 ± 9852 9.653 < 0.0001

u ESR 3.23 ± 9.07 4.95 ± 20 27.8 < 0.0001

Platelets 1.1 ± 1.9 1.2 ± 1.6 -2.770 0.0058

MPV 0.5 ± 8.6 1.1 ± 10 17.418 < 0.0001

The sensitivity of the test is 95% and specificity is 93% positive 
predictive value of 95%  wharesas negative predictive value is 
93% with a MPV cutoff value of 9.2fl. Area under curve is 0.972

       
       
       
   



J Nepal Paediatr Soc | VOL 42 | ISSUE 02 |MAY-AUG,  2022 59

Original ArticlePlatelet Volume as a marker of sePsis

Figure 1 Receiver Operating Curve of MPV

0

20

40

60

80

100
MPV

0 20 40 60 80 100
100-Specificity

S
en

si
tiv

ity

AUC = 0.972
P < 0.001

Discussion
Sepsis remains to be one of the most important causes for neonatal 
mortality. To prevent further complications of sepsis, we need to 
diagnose early and treat it.1 Present study aimed to determine 
the role of MPV as a diagnostic marker of neonatal sepsis. 
The easily accessible, cheap, and common laboratory tests for 
are very important in determining the screening of the disease 
in neonatal sepsis. MPV is universally available with routine 
blood counts by automated hemograms and a simple and easy 
method of assessing platelet function in correlation with sepsis. To 
achieve a larger surface, platelets go through changes in structure 
during activation. Their shape varies from discoid to spherical 
and pseudopodia are also formed. Platelet vertical diameter is 
important in determining platelet volume, which is achieved by a 
hematology analyzer, using deformation of electrical field, based 
on impedance technology. Volume is determined by measuring 
the cross diameter of the platelet cell using analyzers with laser 
optical technology. Consequently, activated platelets seem larger 
in surface area independently of the principle of measurement.2 
In recent studies it has been reported that MPV is increased in 
RDS, NEC, BPD IVH, acute appendicitis etc.3-6 There have been 
previous studies that have looked at the co-relation between the 
MPV and neonatal sepsis. In present study, MPV was significantly 
higher (10 ± 1.1) in the study group as compared to the control 
group (8.6 ± 0.5). Similar results were found in the study done 
by Prathyusha et al where 106 neonates included in the study 
showed statistically significant MPV difference between the study 
groups (mean 12.8 ± 1.52, 10.82 ± 1.20 respectively) at a cut 
of value of 10.2 fl and a sensitivity of 93%, specificity of 84 % 
with a positive predictive value of 83% and negative predictive 
value of 94%.7 Difference of cutoff is there which may be because 
of age difference / preterm neonates as well as from different 
MPV measurement methods. In a study done by Mehmet Yekta 
Oncel et al, a total of 100 patients with sepsis (35 with proven 
sepsis and 65 with clinical sepsis) and 50 healthy controls were 

enrolled. Comparison of markers of sepsis obtained at baseline 
revealed MPV levels to be significantly higher in newborns with 
sepsis compared to healthy controls p value 0.001.4 Similar 
finding of 82 % sensitivity was seen in a study conducted by 
Aydin B et al at a cut off value of 10.4 fl.

Also recently a study done by Yao et al found that out of 315 
neonates who were confirmed to have sepsis divided into two 
groups: proven sepsis (with a positive blood culture; n = 207) 
and clinical sepsis (with a clinical diagnosis; n = 108) with 132 
hospitalized neonates with noninfectious diseases were enrolled 
as the control group. Here MPV was significantly higher in the two 
sepsis groups than in the control group (P <  0.05) with optimal 
cut-off point of 11.4 fL, with sensitivity of 40.5% and specificity 
of 88.4%.8 In the study done by Catal F, preterm neonates were 
grouped as control (n = 100) and sepsis (n = 91). MPV value 
of 10.35 fl was identified as the cut off to identify patients with 
probable sepsis with a sensitivity of 97.8% and specificity of 
78.7% and a MPV value of 10.75 fl was determined as the cut off 
value for patients with high risk of mortality (death) at diagnosis of 
sepsis with a sensitivity of 95.2% and a specificity of 84.9%.9 In 
contrast to present study, Aksoy et al concluded that there was no 
significant difference in MPV between septic and control babies. 
This may have resulted as they had mainly done their study on the 
respiratory infection (respiratory syncytial virus) in preterms and 
extremely low birth weight newborns which we had excluded in 
our study.10

Platelets have an important role in thrombogenesis.11 The 
correlation between platelet activation and adverse clinical 
outcome of vascular diseases including coronary artery disease 
(CAD), stroke, and venous thromboembolism has been established. 
The mechanism of alteration of platelet function in sepsis is still 
unclear. Young platelets are larger as compared to older ones. 
Inflammation induce platelets production by over consumption 
resulting in increase in the young platelets in peripheral smear. 
In comparison to small platelets, larger platelets are functionally, 
metabolically, and enzymatically more active as they contain 
more intracellular thromboxane A2 and increased expression of 
procoagulant surface proteins such as p-selectin and glycoprotein 
IIIa, causing greater prothrombotic potential. Moreover, platelet-
neutrophil interactions and platelet-endothelial interactions 
facilitate a variety of immune activation instances.12-15 By this MPV 
also increases as well as the number of young platelets. 

Conclusions
Neonatal sepsis is almost always accompanied by 
thrombocytopenia. Although important platelet indices are readily 
available, they are less studied among neonates. MPV can be 
used as an additional marker along with established septic screen 
to ensure early diagnosis and treatment of neonatal sepsis with 
no additional expense as it simply generated with CBC. Our 
case-control study concluded that MPV increases significantly in 
neonates with sepsis. However further studies also need to be 
carried out for serial monitoring of MPV with sepsis so that can 
show changes with treatment also.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Oncel%20MY%5BAuthor%5D&cauthor=true&cauthor_uid=23143634
https://www.ncbi.nlm.nih.gov/pubmed/?term=Oncel%20MY%5BAuthor%5D&cauthor=true&cauthor_uid=23143634


J Nepal Paediatr Soc | VOL 42 | ISSUE 02 |MAY-AUG,  202260

Original Article Platelet Volume as a marker of sePsis

References
1. Muthukumaran N. Mortality profile of neonatal deaths 

and deaths due to neonatal sepsis in a tertiary care center 
in southern India: a retrospective study. Int J Contemp 
Pediatr. 2018 Jun 22;5(4):1583–7.    
DOI: http://dx.doi.org/10.18203/2349-3291ijcp201825 
69 

2. Ates S, Oksuz H, Dogu B, Bozkus F, Ucmak H, Yanıt F. Can 
mean platelet volume and mean platelet volume/platelet 
count ratio be used as a diagnostic marker for sepsis and 
systemic inflammatory response syndrome? Saudi Med J. 
2015 Oct;36(10):1186–90.     
DOI: 10.15537/smj.2015.10.10718 

3. Canpolat FE, Yurdakök M, Armangil D, Yi≤it S. Mean platelet 
volume in neonatal respiratory distress syndrome. Pediatr Int 
Off J Jpn Pediatr Soc. 2009 Apr;51(2):314–6.   
DOI: 10.1111/j.1442-200X.2009.02820.x. 

4. Oncel MY, Ozdemir R, Yurttutan S, Canpolat FE, Erdeve O, 
Oguz SS, et al. Mean platelet volume in neonatal sepsis. 
J Clin Lab Anal. 2012 Nov;26(6):493–6.   
DOI: 10.1002/jcla.21552. 

5. Cekmez F, Tanju IA, Canpolat FE, Aydinoz S, Aydemir G, 
Karademir F, et al. Mean platelet volume in very preterm 
infants: a predictor of morbidities? Eur Rev Med Pharmacol 
Sci. 2013 Jan;17(1):134–7.    
PMID: 23329535

6. Erdem H, Aktimur R, Cetinkunar S, Reyhan E, Gokler 
C, Irkorucu O, et al. Evaluation of mean platelet volume 
as a diagnostic biomarker in acute appendicitis. Int J 
Clin Exp Med. 2015;8(1):1291–5.    
PMCID: PMC4358583 

7. Prathyusha, Shreekrishna GN, Bhatt S, Sahana P. Mean 
platelet volume (MPV) as a diagnostic marker in neonatal 
sepsis. Int J Contemp Pediatr. 2019 Apr 30;6(3):1036.  
DOI: http://dx.doi.org/10.18203/2349-3291.
ijcp20191008 

8. Yao Y, Tu Y, Lu Q. [Values of C-reactive protein, percentage 
of neutrophils and mean platelet volume in early diagnosis 
of neonatal sepsis]. Zhongguo Dang Dai Er Ke Za Zhi 
Chin J Contemp Pediatr. 2015 May;17(5):425–9.  
DOI:10.7499/j.issn.1008-8830.2015.05.002

9. Catal F, Tayman C, Tonbul A, Akça H, Kara S, Tatli MM, et al. 
Mean platelet volume (MPV) may simply predict the severity of 
sepsis in preterm infants. Clin Lab. 2014;60(7):1193–200.                                     
DOI: 10.7754/clin.lab.2013.130501 

10. Aksoy HT, Eras Z, Guzoglu N, Canpolat FE, Dilmen U. 
Mean platelet volume is not associated with bacterial sepsis 
in newborns. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 
2013 Dec;17(12):e1263.     
DOI: 10.1016/j.ijid.2013.05.010. Epub 2013 Jul 12. 

11. Davì G,  P  Carlo. Platelet Activation and Atherothrombosis 
| NEJM [Internet]. [cited 2020 Oct 3]. Available from: 
https://www.nejm.org/doi/full/10.1056/NEJMra071014 
DOI:10.1182/blood.V63.6.1372.bloodjournal6361372

12. Thompson CB, Jakubowski JA, Quinn PG, Deykin D, Valeri 
CR. Platelet size as a determinant of platelet function. J 
Lab Clin Med. 1983 Feb 1;101(2):205–13.   
PMID: 6822760 

13. Size dependent platelet subpopulations: relationship of 
platelet volume to ultrastructure, enzymatic activity, and 
function - Thompson - 1982 - British Journal of Haematology 
- Wiley Online Library [Internet]. [cited 2020 Oct 3].  
DOI: 10.1111/j.1365-2141.1982.tb01947.x

14. Zarbock A, Polanowska-Grabowska RK, Ley K. Platelet-
neutrophil-interactions: linking hemostasis and inflammation. 
Blood Rev. 2007 Mar;21(2):99–111.    
DOI: 10.1016/j.blre.2006.06.001. Epub 2006 Sep 20

15. L Vizioli, S Muscari, A Muscari, The relationship of mean 
platelet volume with the risk and prognosis of cardiovascular 
diseases - Vizioli - 2009 - International Journal of Clinical 
Practice - Wiley Online Library [Internet]. [cited 2020 Oct 
3].        
DOI: 10.1111/j.1742-1241.2009.02070.x 


