الفهرس 
Neonatal SepsisOnly 14 pages are availabe for public view
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Abstract
Epsis is still one of the most important causes of mortality and morbidity in the neonatal period. Diagnosis of sepsis is very difficult as the early signs may be subtle and different at different gestational age, in addition the diagnosis of sepsis based on blood culture is usually delayed (Bouchon et al., 2001).
There is need for an invallible test or combination of tests for neonatal sepsis that are easily performed and quick availability of reports that can identify infected infants at the time of initial assessment.
The triggering receptor expressed on myeloid cells-1 (TREM-1) is a recently discovered member of the immunoglobulin superfamily. Studies have shown that the expression of TREM-1 is greatly upregulated in the presence of bacteria, or fungi (Bouchon et al., 2001).
In an attempt to evaluate the role of sTREM-1 in the diagnosis of neonatal sepsis, our study was conducted on 60 neonates; 40 cases approved to have sepsis according to clinical picture and hematological scoring system (Rodwell et al., 1993) they were compared to control group of 20 healthy babies.
In this study we found that sTREM-1 level was statistically significantly higher in septic patients with mean ± SD (4289.8± 2931.15) pg/ml compared to healthy group with mean ± SD (1300.4±388.03) pg/ml and P-value (<0.001).
The level of sTREM-1 was also found to be higher in non survivor group with mean ± SD (5201.6 ± 3254.7) pg/ml compared to survivor group with mean ± SD (2770.1 ± 1347.2) pg/ml.
There was positive correlation between sTREM-1 level and other markers of sepsis like CRP, total leucocytic count, I/T ratio and negative correlation as regard to platelets count.
Using receiver operating characteristic (ROC) curve we found that sTREM-1 value of 2306.5 pg/dl has the highest diagnostic senstivty of sepsis 72.5% and specificity 100% with area under the curve (AUC) 96.2%.while at the level of 2485 pg/ml sTREM-1 predicts death with senstivty 68.6% and specificity 80% with AUC 61.7%
Our septic cases had positive blood culture in 90% of cases. Klebsiella represents about 27.5% of the cases followed by Streptococci 17.5%.
Our results showed the significance of sTREM in diagnosing sepsis and its prognostic value as regards to morbidity and mortality.
Further studies on larger scales are needed to evaluate such findings and verify use of sTREM in sepsis management and its futuristic role in providing optimal care to neonates admitted to NICU with suspected sepsis.
Conclusion & recommendations
• sTREM-1 was found to be of significant diagnostic and prognostic value in neonatal sepsis in neonates of more than 34 week gestational age.
• sTREM-1 values were much higher in septic babies compared to healthy control babies and results were statistically significant ( P-value<0.001)
And in non survivors among septic babies compared to survivors (P-value<0.009).
• The best diagnostic value of sTREM as a marker of sepsis was 2306.5pg/dl with a sensitivity of 72.5% and specificity of 100%.
• The best prognostic value of sTREM to predict mortality in septic neonates was 2485 pg/dl with a sensitivity of 68.6% and specificity of 80%.
• Larger studies are needed to consolidate the value of sTREM in the management of neonates admitted to NICU with sepsis manifestations as diagnostic and prognostic marker.
• Further studies to role out whether sTREM-1 is affected by other diseases pathology in neonates as RDS, hemorrhagic diseases of newborn, HIE or surgical conditions.