الفهرس 
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Abstract
The aim of this study investigated the hypothalamicpituitary- adrenal axis response in preterm and full-term neonates diagnosed with neonatal sepsis. Methods: Plasma cortisol (9 am and 9 pm) and ACTH (9 am and 9 pm) and plasma cortisol level post ACTH stimulation test (9 am and 9 pm) in 60 neonates with sepsis (30 preterm and 30 full term) admitted to neonatal intensive care center (NICU). They were compared to 30 neonates without evidence of sepsis as a control group. Gender, gestational age, weight, mode of delivery, post-natal age, and antenatal risk factors morbidities, APGAR score, type of sepsis and pharmacotherapy were analyzed Results: Serum cortisol level and ACTH at 9 am and 9 pm were markedly reduced in both neonatal groups with sepsis compared with the control group (P<0.001, 0.001) respectively but no significant difference between the full term and preterm group with loss of circadian variation in all studied neonates. After ACTH stimulation test no significant changes occurred in either group with sepsis when compared with the corresponding baseline cortisol level. Relative adrenal insufficiency was depicted in 78% of neonates with sepsis with no significant difference between preterm and full term. Pearson correlation coefficient was utilized to find the relationship of serum cortisol levels, ACTH levels and all demographic, clinical and laboratory findings. Only HSS score and C reactive protein (CRP) level were correlated with serum cortisol level at (9 am: r=-0.273, P<0.035 and r=- 0.447, P<0.001), (9 pm: r=-0.447, P<0.001and r=-0.477, P<0.001) ACTH at (9 am:r=-0.314, P<0.015 and r=-0.377, P<0.003) and at (9 pm: r= -0.362, P<0.005 and r=-0.448, P<0.001) and cortisol level post ACTH stimulation (r=-0.345, 0.007 and r=-0.497, P<0.001) respectively Relative adrenal insufficiency was prevalent in 78 % of neonates with sepsis. While it was not related to gestational age or any other clinical variables in preterm and full- term neonates, it was predominantly related to the sepsis severity.