الفهرس 
Neonatal SepsisOnly 14 pages are availabe for public view
 |  | from | 128 |  |  |
| | | from | 128 | | |
Abstract
Neonatal sepsis is a major cause of mortality in neonates in the developing countries.
The value of diagnosis of neonatal septicemia and finding a novel biomarker is to assist in discovering the occurrence of sepsis as soon as possible to begin the proper management to lower mortality and also long term morbidity. In the existing study we pointed to assess the sensitivity and accuracy of using Activin A as a biomarker for timely diagnosis of neonatal sepsis to start management.
The aim of this work was to study the level of Activin A biomarker in serum of neonates with sepsis.
A case control study had been carried out from April 2022 to April 2023 at neonatal intensive care unit at Sers ellayan and Menouf General hospitals. It had been conducted on ninety neonates classified into two groups:
group I (patient group): forty five neonates (15 preterm and 30 full-term) with age range 2 – 23 days. The male gender was 64.4% versus female gender 35.6 %. The patients were chosen as neonates with suspected sepsis by the presence of sepsis risk factors in the baby or findings suggesting sepsis in follow-up.
1. Risk factors:
Premature babies with low birth weight have a risk of developing sepsis three to ten times higher than full-term babies with normal birth weight (Shane et al., 2017).
Summary
85
Low APGAR score, resuscitation of the baby and the multiple pregnancies increase the risk of early-onset sepsis (Satar et al., 2018).
Invasive procedures, such as frequent blood sampling, intubation, mechanical ventilation, catheter/probe insertion, insufficient breastfeeding, long-term parenteral nutrition, low stomach acid and surgical interventions especially increase the risk of late-onset sepsis (Satar et al., 2018).
Inadequate antenatal care, high rate of home birth, unsanitary birth and umbilical cord care practices, and late recognition of conditions that pose a risk of infection in the mother or baby in developing countries (Odabasi and Bulbul, 2020).
2. Clinical signs:
Modified body temperature: core temperature greater than 38,5 °C or less than 36 °C and/or temperature instability.
Cardiovascular instability: bradycardia (mean HR less than the 10th percentile for age in the absence of external vagal stimulus, betablockers or congenital heart disease or otherwise unexplained persistent depression over a 0.5 h time period) or tachycardia (mean HR greater than 2 SD above normal for age in the absence of external stimulus, chronic drugs and painful stimuli or otherwise unexplained persistent elevation over a 0,5 h to 4 h time period) and/or rhythm instability. Reduced urinary output (less than 1 mL/kg/h), hypotension (mean arterial pressure less than the 5th percentile for age), mottled skin and impaired peripheral
Summary
86
perfusion. Skin and subcutaneous lesions: petechial rash and sclerema.
3. Laboratory signs:
White blood cells (WBC) count: <4,000 x109 cells/L or >20,000 x109 cells/L.
Immature to total neutrophil ratio (I/T) greater than 0.2
Platelet count <100,000 x109 cells/L.
C reactive protein > 15 mg/L or procalcitonin ≥ 2 ng/ml (The cut-off for procalcitonin in neonatal sepsis has not been clearly defined, as the currently available published data are still controversial).
Glucose intolerance confirmed at least 2 times: hyperglycaemia (blood glucose >180 mg/dL or 10 mMol/L) or hypoglycaemia (glycaemia < 45 mg/dL or 2.5 mMol/L) when receiving age specific normal range glucose amounts.
Metabolic acidosis: Base excess (BE) <-10 mEq/L or Serum lactate > 2 mMol/L (European Medicines Agency, 2021).
group II (Control Group): forty five apparently healthy neonates (12 preterm and 33 full term) aging 2-21 days.
Exclusion Crieria:
1- Any congenital anomalies and syndromes.
2- Central nervous system malformations, birth asphyxia and intracranial hemorrhages as the level of Activin A may increase in these cases (Florio et al., 2010).
3- Neonates with respiratory distress syndrome.
Summary
87
An informed written consent was obtained from subjects participated in this study.
The study design was approved by the appropriate ethics review board, followed the tenets of the Declaration of Helsinki and was approved by the ethics committee of the Faculty of Medicine, Menoufia University (IRB number: 9/2021 PEDI23).
Methods:
All participants were subjected to the following:
1. Full history taking (antenatal, natal and postnatal) including risk factors for sepsis.
2. physical clinical examination :
a. General examination (vital signs, colour, conscious level, assessment of gestational age according to new Ballard score).
b. Systemic examination (CNS, CVS, Chest, Abdomen )
3. Hematological score of sepsis.
4. Routine laboratory tests :
Complete blood count (CBC)
C-Reactive Protein
Blood culture
5. Specific test: quantification of serum Activin A was measured using human Activin A ELISA kit (Shanghai sunred Biological Technology Co., China) according to the manufacture’s instruction.
Summary
88
The results of the present study can be summarized as follows:
o There was non-significant statistical difference between the two studied groups regarding consanguinity, age in days, gender and gestational age in weeks.
o There was non-significant statistical difference between the two studied groups regarding maternal age, gravidity, parity and abortion.
o There was significant statistical difference between the two studied groups regarding neonatal fever but there was non-significant statistical difference regarding neonatal jaundice, IUGR and prematurity. There was non-significant statistical difference between the two studied groups regarding CS, DM, HTN, UTI and PROM .
o 33.3% of the cases showed decreased urine output, 31.1% showed mottling, 75.6% showed impaired perfusion, 17.8% showed peticheal rash, 24.4 % showed sclerema, 35.6 % showed fever.
o There was significant statistical difference between the two studied groups regarding heart rate, MBP and temperature (p=<`0.001, 0.011, 0.037 respectively) but there was non-significant statistical difference regarding respiratory rate.
o There was significant statistical difference between the two studied groups regarding glucose intolerance (p=<0.001), CRP (p=<0.001), WBCs (p=<0.001) decrease in platelet (p=0.026) and base excess (p=0.021) in neonates with sepsis group when compared to control group.
Summary
89
o The results of blood cultures of group one. 31.1 % of the cases showed klebsiella growth, 31.1% showed Staph. aureus growth, 22.2% showed enterobacter growth and 15.6% showed no growth.
o There was significant statistical increase of Activin A level in neonates with sepsis group when compared to control group.
o Hematological score of sepsis in group one, the mean of hematological score of sepsis was 5.89 ± 0.83, Regarding Tollner sepsis scoring in neonates with sepsis, the Mean ± SD was 7.69 ± 1.39 and the median was 7.
o In neonates with sepsis group, there was significant statistical association between increased serum Activin A levels and hematological score of sepsis.
o There was significant difference regarding onset of disease (lower than 3 days versus higher than 3 days) and gestational age (preterm versus full- term) in neonates with sepsis.
o There was significant statistical association between increased serum Activin A level and Tollner sepsis scoring in neonates with sepsis.
At AUC 0.962 (95% CI: 0.915 – 1.0) and cut off point of > (190.89), the sensitivity of Activin A level to differentiate between neonates with sepsis and controls is (93.33%), the specificity is (88.89%), the positive predictive value is (89.4%) and the negative predictive value is (93%).