الفهرس 
NEONATAL SEPSIS
EtiologyOnly 14 pages are availabe for public view
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Abstract
The function of the hemostatic system is to maintain the
balance between the procoagulant and anticoagulant forces
through precisely interacting systems and pathways.
Disturbance in this balance may lead to bleeding tendency or a
hypercoagulable state. The latter state occurs when the
procoagulant forces take the upper hand.
Many risk factors may contribute to the development of
thrombosis either genetic or environmental. Neonates seem to
be at high risk to develop thrombosis which might be due to
their under developed hemostatic system, stress of delivery or
the invasive procedures and risky environment they become
prone to after delivery.
DIC is one of the most common and fatal complications
of neonatal hypercoagulability. Among all the causes of DIC,
sepsis is the most prevalent condition causing DIC in neonates.
Neonatal sepsis is a syndrome of circulatory compromise
caused by invasion of the blood stream by different organisms.
Either maternal or fetal factors may lead to development of
sepsis; so, the diagnosis rely on combining the history and
clinical features with the laboratory and imaging studies.
Diagnosis of DIC in neonates is a very difficult issue,
and the implementation of any of the developed scoring
systems to diagnose DIC in neonates is still limited. Using a
combination of laboratory tests, longitudinal assessment of patient’s coagulopathy as well as appearance of new diagnostic
markers such as SFMC help to make the diagnosis of DIC more
possible.
In this study we aimed at identifying the presence of a
hypercoagulable state in sick newborns by studying the
behavior of SFMC with special reference to those of other
coagulation tests and evaluating the role of SFMC in early
diagnosis of DIC in sick newborns.
The study was conducted on forty neonates hospitalized
in the neonatal intensive care unit of Ain Shams University
hospitals. Neonates with congenital anomalies that might be
associated with tissue hypoxia were excluded. After taking an
informed consent from parents or guardians, full history and
clinical examination were done as well as laboratory tests
including CBC, coagulation profile (PT, PTT, fibrinogen level
and D- dimer), CRP, blood gas analysis, lactate and SFMC. In
the present study, we used a latex turbidimetric immunoassay
for the measurement of SFMC using anti-fibrin monomer
monoclonal antibody.
The studied patients were categorized into different
groups and subgroups based on birth weight, gestational age
and lactate level (serum lactate level ≥ 4mmol/L was selected
to define tissue hypoperfusion based on SSC guidelines).
On comparing different groups and subgroups, the results
revealed that SFMC levels were found to be higher in low birth
weight infants suggesting the fact that they are more prone for developing DIC. On the other hand, it was only the DD that
showed difference among the two gestational age groups. In
addition, our results revealed significantly high levels of SFMC
in association to increased lactate level, which may indicate
that hypoperfusion induces more pronounced changes in
coagulation and fibrinolysis.
These results present SFMC, when compared to Ddimer, as a valuable tool in the diagnosis of DIC especially
when tissue hypoxia is an antecedent cause of DIC. Also,
SFMC would detect the development of DIC when the value of
fibrinogen level and D-dimer is limited as in case of preterm
infants.