الفهرس 
Neonatal sepsisOnly 14 pages are availabe for public view
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Abstract
This study was carried out in the maternity hospital of Ain Shams University during a period of five months from February 2005 to June 2005.
It was conducted on 52 neonates; 32 neonates with risk factors for early onset neonatal sepsis (EOS) in the NICU and 20 healthy neonates with no risk factors for early onset neonatal sepsis collected from the general care nursery. All neonates were followed up for 4 days for appearance of any clinical or laboratory sign of sepsis. All neonates had birth weight appropriate for gestational age.
Exclusion criteria
8. Small for gestational age neonates.
9. A history suggesting perinatal asphyxia.
10. Treatment with medications that can alter the splanchnic circulation as dopamine or indomethacin.
All neonates were subjected to history tacking with stress on risk factors for EOS together with clinical examination searching for signs of EOS in the form of respiratory distress signs, cardiovascular manifestations, neurological manifestations,
and gastrointestinal manifestations.
The following investigations were done
7. Capillary blood gases.
8. Complete blood picture
vii. Total leukocytic count.
viii. Neutrophil count.
ix. I/T ratio.
x. Abnormal forms of neutrophils.
xi. Platelet count.
xii. Hemoglobin level.
9. C-reactive protein: Serial semiquantitative measurements of CRP were done.
10. Blood culture
11. Chest X-ray: Searching for pneumonic patch or patches and cardiomegaly.
12. Preentral Doppler ultrasound on the SMA and celiac axis.
After completing the study, the 52 neonates were retrospectively divided into 3 groups as follows:
Group1 (sepsis group): it comprised 20 neonates having risk factors for EOS & developed sepsis. They have a mean gestational age (GA) of 35.7 ± 2.19 weeks and a mean birth weight (BW) of 2.41 ± 0.61 Kg. Eleven (55%) were preterms (PT) & 9 were (45%) full terms (FT), with a male to female ratio of 12/8.
Group 2 (at risk group):it comprised 12 neonates having risk factors for EOS and did not develop sepsis. They have a mean of GA 35.9 ± 1.92 weeks, a mean BW 2.65 ± 0.73 Kg. Six (50%) were preterms & six (50%) were full terms, with male to female ratio 1/1.
Group 3 (control group): it comprised 20 healthy neonates. They have a mean GA of 36.3 ± 1.71 weeks and mean BW of 2.63 ± 0.62 Kg. Eleven (55%) were preterms & nine (45%) were fullterms, with a male to female ratio 11/9.
Cases were further divided into 2 subgroups; culture proven sepsis (n=15) and non culture proven sepsis (n=5).
The most common maternal risk factor for sepsis was PROM>18hr and the most common neonatal risk factor was prematurity.
The most common clinical presentation of septic neonates was respiratory distress (90%) followed by poor perfusion (55%) and poor suckling (10%).
There was no significant difference between the 3 groups as regard the demographic data; gestational age, sex, birthweight.
There was a significant difference between the 3 groups as regard the Apgar sore at 1 and at 5 min, with lowest Apgar sores recorded in the sepsis group.
As regards the pathogens encountered in this study, Klebsiella was the most common offending pathogen followed by MRSA then Staphylococcus aureus.
As regards the hematological profile there appeared a significant difference between the 3 groups in the CRP with titre, platelet count, WBC count and I/T ratio together with a non significant difference between the 3 groups as regard the neutrophil count.
As regards the superior mesenteric blood flow, there was a significant decrease in septic neonates than the healthy neonates despite a reduction in the flow impendence.
As regards the celiac blood flow, it was increased in the septic neonates than the healthy neonates together with a significant reduction in the flow impendence.
So, our study showed definite changes in the splanchnic circulation occurring in neonates with early onset neonatal sepsis as early as the first day of life. These changes are in the form of increased celiac axis blood flow; on the expense of the SMA blood flow.