الفهرس 
Aim of the workOnly 14 pages are availabe for public view
 |  | from | 135 |  |  |
| | | from | 135 | | |
Abstract
Neonatal infection defined as a systemic inflammatory response .
Neonatal sepsis are classically divided into two distinct clinical syndromes:
early-onset sepsis (EOS) and late-onset sepsis (LOS).
In routine clinical practice, it is difficult to diagnose neonatal sepsis
rapidly and accurately due to various reasons. Therefore, the accuracy of
diagnostic tests should be improved.
Clinical diagnosis of sepsis in neonates is difficult because many of
the symptoms relating to sepsis are obscure as they can occur with other
noninfectious diseases. The main point in treatment is an early diagnosis
and appropriate treatment with antibiotics, and the importance of suspicion
index based on clinic and laboratory parameters should be emphasized .
A new acute-phase protein called pentraxin 3 (PTX3) has a potential
to fulfill those requirements. An increase in serum PTX3 level was observed
as early as in the 1st hour after the occurrence of proinflammatory signals,
reaching the maximum value between the 2nd and 6th hours .
This study aimed to study cord blood PTX3 level as possible marker
for early diagnosis of neonatal sepsis in relation to clinical and laboratory
findings.
Patients and methods:
This prospective case-control study included 135 neonates admitted to
the NICU.
Studied neonates were classified into two groups:
I) Patients group:
This group included 68 full term neonates diagnosed as suspected
sepsis and was further subgrouped into:
Summary
- 86 -
group 1a (Culture confirmed sepsis): included full term neonates
with proven sepsis diagnosed by positive blood culture.
group 1b (Clinical sepsis): included full term neonates with clinical
sepsis (with negative blood culture) with the presence of two or more
clinical symptoms or signs of infection:
II) Controls group:
This group included 67 neonates of matched age and sex with no
symptoms and signs of sepsis. These neonates were admitted to the NICU
due to suspicion of other diseases not related to sepsis.
Inclusion criteria:
Full term neonates admitted to NICU.
Gestational age ≥37 weeks.
Symptoms and Signs suggestive of early-onset clinical infection .
Exclusion criteria:
Neonates who had lethal congenital or suspected chromosomal
abnormalities and those whose siblings have suspected
immunodeficiencies.
Neonates with acute renal injury and those exposed to perinatal
asphyxia.
Maternal drug abuse.
Intracranial hemorrhage.
All neonates were subjected to: detailed history, clinical examinations,
routine lab (CBC, ABG, hepatic and renal functions, electrolytes ,random
blood glucose, and C-reactive protein), and specific lab investigations (
pentraxin 3 level and blood culture).
Pentraxin level was measured twice, in cord blood of both groups and
in venous blood < 3days postnatal for patients group only.
Summary
- 87 -
The results of the current study showed:
1. Demographic data: males were significantly higher in patients group.
2. Maternal diseases: as PROM was significantly higher in patients group compared to the controls group.
3. Fetal risk factors: (apgar score at 1 and 5 min) were significantly lower in the patients group compared to the controls group. And (downs’ score) was significantly higher in the patients group.
4. Clinical data: (need for oxygen RR and clinical presentation include (poor feeding, hypoactivity and pneumonia ) were significantly higher in the patients group compared to the controls group. The mean total clinical scores in the patients group was 4.21, indicating that clinical scores can detect sepsis.
5. Laboratory data:
TLC was significantly higher in the patients group.
PH, PCO2 ,SPO2 were significantly lower in the patients group.
HCO3 was significantly higher in the patients group.
CRP was significantly higher in the patients group.
Positive blood culture organisms were as follows: 27 patients had streptococcus, 12 patients had klebsiella, 5 patients had staph aureus, 13 patients had non-staph aureus in the patients group.
Cord blood pentraxin 3 level was significantly higher in the patients group, and serum pentraxin 3 level was significantly decreased after 3 days with a mean 10.7 ng / ml.
Cord blood pentraxin 3 level was also higher in the confirmed sepsis compared to suspected patients, and serum pentraxin 3 level was significantly decreased after 3 days.
Positive correlation between cord blood pentraxin 3 level and RR, downs’ score, and CRP.
Summary
- 88 -
Hospital stay was significantly prolonged in the patients group.
The diagnostic performance of PTX3 to detect neonatal sepsis yielded an area under curve (AUC) of 0.97 and a cut-off value to detect sepsis > 2.55 ng/mL with sensitivity 96.5%, sepcificity 93% and accuracy 95%.
Conclusion:
Cord blood pentraxin 3 level could be used as a reliable early marker of neonatal sepsis.
Recommendation:
Early measurement of cord blood PTX3 for may be useful for early diagnosis of neonatal sepsis. It is recommended in full term neonates and follow up of its level for maintaining therapeutic response of the patients.