الفهرس 
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Abstract
Neonatal sepsis continues to be a major cause of morbidity and mortality in the newborn. This is despite improvement in antimicrobial therapy, advances in neonatal life support measures, and the prompt recognition of perinatal risk factors for infection.
Accurate diagnosis of neonatal sepsis is difficult because of the imperfect diagnostic sensitivity of independent laboratory tests. All predisposing factors to infection such as prenatal history, clinical presentation of the newborn, and laboratory results must be considered to treat all those who have infections and yet minimize the use of antibiotics in those without infection.
A better understanding of the neonatal inflammatory response to infection has led to the identification of multiple diagnostic markers of sepsis. At present, there is no single test, marker, or panel of markers that is sufficiently reliable for the early detection of neonatal sepsis. Complicated analytical measurements are both time consuming and costly and are therefore not readily available for use in clinical practice. None of the current diagnostic markers are sensitive or specific enough to influence the decision to withhold antibiotic therapy but hold promise for the early discontinuation of antibiotic treatment with suspected sepsis. Further evidence from large multicenter trials is needed to evaluate the newer diagnostic markers prospectively for their incremental diagnostic value before they can be considered reliable for diagnosing early infections and be included as part of a routine sepsis evaluation for neonates.
The early signs of neonatal sepsis may be subtle, different at different gestational ages. In most NICUs, this difficulty in distinguishing the infected from non-infected infants had resulted in administration of antimicrobial drugs in a very high proportion of cases. The diagnosis of neonatal sepsis begins with clinical suspicion. The challenge for the neonatal practitioner is to decide which babies need empirical antibiotic therapy. Unfortunately there is no single diagnostic test, which can reliably diagnose sepsis in the newborn, therefore many diagnostic tests are utilized to diagnose or confirm sepsis.
The gold standard establishing the diagnosis of neonatal sepsis is the isolation of a pathogen from one or more blood cultures.
In this study, we aimed at studying the utility of Neutrophils CD11b and CD64 for the early diagnosis of neonatal sepsis and compare them with other diagnostic parameters.
CD11b is a subunit of the b2 integrin adhesion molecule. It is normally expressed at a very low concentration on the surface of non-activated neutrophils. Its expression, however, increases considerably within a few minutes after the inflammatory cells come into contact with bacteria and endotoxins. There were highly significant differences CD 11b level between septic and control groups, the sensitivity of CD11b was 97.5%, the specificity was 95%. Neutrophils CD11b expression is significantly increased in neonates with neonatal sepsis.
CD64 is a high –affinity and restricted isotype –specificity FcyRI receptor expressed on macrophage, monocytes, neutrophilis, there are several reports regarding its utility for the diagnostic assessment of sepsis or infection in adults and neonates.
There were also highly significant differences CD 64 level between septic and control groups, the sensitivity of CD64 was 95% and the specificity was 95%.
Neutrophil CD11b and CD 64 expression measurement are useful tools in the early diagnosis of neonatal sepsis. They are more specific and sensitive markers than other laboratory work of sepsis .In comparison to blood culture, CD 11b and CD64 levels are highly sensitive and specific as early markers of neonatal sepsis.
Blood culture results are not available until 24-72 hours, and they are often negative in cases of pneumonia and meningitis, or even in fatal generalized bacterial infection.
Conclusion and Recommendations
• Early diagnosis of neonatal sepsis is important to help early treatment and improves the treatment outcome.
• It is concluded that neutrophils CD11b expression is significantly increased in neonatal sepsis and correlated well with other laboratory markers of sepsis.
• Neutrophils CD64 expression is also significantly increased in neonates with neonatal sepsis and correlated well with other laboratory markers of sepsis.
• Neutrophils CD 11b and neutrophils CD 64 expression measurements are useful tools in the early diagnosis of neonatal sepsis. They are more specific and sensitive markers than other laboratory markers.
According to the results of the present work we recommend:
• Early diagnosis of neonatal sepsis is important to help early treatment and to improve the infant outcome.
• Neutrophil CD 11b and neutrophil CD 64 expression measurements are useful tools in the early diagnosis of neonatal sepsis. It is more specific and sensitive than other laboratory work of sepsis. They help early diagnosis and treatment of neonatal sepsis before any other methods of diagnosis.
• Further studies are needed to assess the incidence of neonatal sepsis with different types.
• The identified CD markers could provide a new gate for prognostic and diagnostic markers for neonatal sepsis, so further studies are needed to identify more specific and sensitive markers for early diagnosis.