This study aimed to evaluate associations between leukopenia or neutropenia at birth and risk of sepsis in very preterm neonates.
 We conducted a retrospective unmatched cohort study of neonates of <32 weeks' gestation. Those with leukopenia (≤5,000/µL) were compared with a unmatched cohort without leukopenia. Comparisons were also made for patients with neutropenia and without neutropenia. The outcomes were early-onset sepsis, late-onset sepsis, and mortality.
 We identified 271 neonates with leukopenia at birth and 271 without. Multivariable analyses identified higher odds of early-onset sepsis (adjusted odds ratio [AOR] = 4.85, 95% confidence interval [CI]: 1.29-18.20) in leukopenic neonates. Of neonates with leukopenia, 183 had both leukopenia and neutropenia and were associated with the highest odds of early-onset sepsis (AOR = 6.94, 95% CI: 1.77-27.15) compared with those with neither or with either alone.
 Leukopenia, neutropenia, and both leukopenia and neutropenia at birth were associated with early-onset sepsis in very preterm neonates.
· Leukopenia and neutropenia combined at birth was associated with highest odds of early-onset sepsis.. · Leukopenia or neutropenia were associated with sepsis in preterm neonates.. · The risk of infection persist throughout neonatal stay in NICU..

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