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Background  Late-onset sepsis (LOS) is a systemic inflammatory response syndrome in neonates, and the molecular mechanism of LOS is incompletely characterized. The purpose of this study was to explore the potential value of receptor interacting protein 3 (RIP3) in LOS.    Methods  63 neonates with LOS supported by positive culture and 79 neonates without sepsis were enrolled in this study from September 2019 to March 2021. Plasma RIP3 was detected by enzyme-linked immunosorbent assay (ELISA) and assessed along with the whole blood hypersensitive C-reactive protein (hs-CRP) level and platelet count (PLT). Differences in RIP3, hs-CRP and PLT between the two groups were compared. Changes in the three indicators in sepsis were also observed after treatment. The diagnostic value of indicators for LOS was evaluated by receiver operating characteristic (ROC) curve analysis.    Results  In the sepsis group, RIP3 and hs-CRP levels were significantly higher than those in the control group (RIP3,  p  < 0.0001; hs-CRP,  p  < 0.0001), and PLT was significantly lower than that in the control group ( p  < 0.0001). After treatment, RIP3 and hs-CRP levels among septic survivors were significantly decreased ( p  < 0.0001) and PLT significantly improved ( p  = 0.0216). With RIP3 > 15,845.19 pg/mL, hs-CRP > 5.00 mg/L, and PLT < 204.00 × 10 9 /L as the positive criteria, the sensitivity values of the three indicators in the diagnosis of LOS were 69.8%, 60.3%, 60.3%, respectively, and the specificity values were 92.4%, 96.2%, 79.8%, respectively. The combination of RIP3, hs-CRP and PLT had a sensitivity of 77.8% and specificity of 97.5%.    Conclusions  RIP3 may contribute to the early diagnosis of LOS and monitoring of treatment effect. The combined detection of RIP3, hs-CRP and PLT may be more effective than individual detection in the diagnosis of LOS.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12879-021-06636-0.

The potential value of plasma receptor interacting protein 3 in neonates with culture-positive late-onset sepsis