Rodwell score
The Rodwell score assigns points to blood-count abnormalities to estimate the probability of neonatal sepsis. Tick the findings present and the calculator adds the points and classifies the risk.
Tick the findings present on the blood count. Each criterion scores 1 point; the absence of mature neutrophils scores 2 and replaces the neutrophil count. Maximum score: 8.
Score ≥ 3: sensitivity 96% and specificity 78%. Score 0 to 2: negative predictive value 99%. The score does not replace blood culture or clinical assessment; interpret together with risk factors and CRP.
Clinical decision-support tool for use by healthcare professionals. It does not replace clinical judgment or your unit's protocols.
Criteria
Seven 1-point criteria: abnormal total leukocyte count, abnormal total neutrophil count, elevated immature neutrophils, elevated immature-to-total (I:T) ratio, immature-to-mature (I:M) ratio ≥ 0.3, degenerative changes in neutrophils and platelets ≤ 150,000/mm³. No mature neutrophils on the smear scores 2 points and replaces the neutrophil-count criterion. Maximum: 8 points.
Interpretation
0 to 2 points: sepsis highly unlikely (negative predictive value 99%). 3 to 4 points: sepsis moderately likely. 5 or more: sepsis highly likely. A score ≥ 3 has 96% sensitivity and 78% specificity.
Example
Newborn at 36 hours of life with leukocytes of 27,000/mm³ (1), I:T ratio of 0.18 (1), toxic granulation in neutrophils (1) and platelets of 120,000/mm³ (1). Score 4: sepsis moderately likely. Obtain a blood culture and interpret together with risk factors and CRP.
Frequently asked questions
Does the Rodwell score confirm sepsis?
No. It estimates probability from the blood count. The diagnosis depends on blood culture, clinical picture and risk factors. The score’s greatest value is in ruling out sepsis when it is low.
Do the cut-offs change with the newborn’s age?
Yes. The limits for leukocytes, neutrophils and the I:T ratio differ in the first 24 hours, between 24 and 60 hours and after 60 hours of life. The values are shown under each criterion in the calculator.
Why does the absence of mature neutrophils score 2 points?
In Rodwell’s original system, this finding is the most severe in the neutrophil series and replaces the total neutrophil-count criterion, so the same abnormality is not scored twice.
References
- Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr. 1988;112(5):761-7.
- Brazilian Society of Pediatrics (SBP). Department of Neonatology. Early-onset neonatal sepsis: diagnosis and treatment. Scientific document.
- Manroe BL, Weinberg AG, Rosenfeld CR, Browne R. The neonatal blood count in health and disease. I. Reference values for neutrophilic cells. J Pediatr. 1979;95(1):89-98.
