الفهرس 
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Abstract
Neonatal sepsis remains a major clinical problem in neonatology, with high morbidity and mortality rates despite the progress in neonatal intensive care and antibiotics. Diagnosis of neonatal sepsis remains as a major challenge as the early signs may be subtle, non specific and the main diagnostic method is the blood culture which take minimum 48 hours for the earliest result and can show no growth despite the clinical signs of sepsis so, there is no single diagnostic test, which can reliably diagnose sepsis in the newborn, therefore a variety of diagnostic infection markers were studied in years.
Apolipoprotein A1 is one these infection markers. Apolipoprotein A1 is the major protein component of high density lipoprotein (HDL) in plasma. The concentration of apo A1were decreased during the acute infection.
This study was done, to evaluate the diagnostic and prognostic value of apolipoprotein A1 in neonatal sepsis.
Our study was conducted on 60 neonates: 40 patients with positive clinical sepsis score and haematological sepsis score. They included (22 male and 18 female). They were compared to a control group of 20 healthy neonates (10 males and 10 females).
All babies were subjected to:
1. History taking.( prenatal, natal and postnatal history taking that included intrapartum fever > 38°C, premature rupture of membranes > 18 hours,difficult labour,mode of delivery.
2. Clinical examination (general and local examination).
3. Laboratory investigations (CBC, Blood culture, Blood glucose liver and kidney function tests, CRP and Apolipoprotein A1 at time of presentation of sepsis and after 96h).
Our study releaved that concerning the demographic criteria in the studied groups, there is no significant difference between the studied groups as regards the gestational age (P>0.05),weight and sex (P>0.05).
The mode of delivery show no statistical difference between the studied groups.
The most frequent risk factors were premature rupture of membranes (PROM) more than 18 hours were found in 35% of cases and prematurity which found in 30% of the studied cases.
The most common clinical findings among patients with proven sepsis were weak suckling and weak moro reflex in 100% of cases.
There is highly statistical significant difference between two groups as regard IT, IM ratios and platelets count. In our study, the cases which had I/T ratio of more than 0.2 represented 100% in the patients groups.
Blood cultures in the septic neonates showed that 75% of cases had positive culture results and 25% of cases had negative culture results and GBS was the most frequently isolated organism.
CRP level was found to be positive (≥6 gm/L) in 100% of patients group and negative in control group.
There was significant increase in CRP at diagnosis in died group (6-96 gm/L) than in survived group (6-24 gm/L) and highly significant increase in CRP after 96 hours (24-96 gm/L) in died group than in survived group (6-48 gm/L) .
The outcome of the diseased group show that 55% were survived and 45% were died.
There was decrease in Apolipoprotein A1 in patients at time of diagnosis with mean (55.33 ± 1.53mg/dl) compared to control group with mean (85.20 ± 1.69 mg/dl) and the difference was statistically significant (p value < 0.001).
There was significant decrease in Apolipoprotein A1 level in survived group at diagnosis with mean ± SD (56.36 ± 1.26) mg/dl compared to after (96h) which decrease with mean ± SD (54.36 ± 1.26) mg/dl (p- value <0.001).
There was highly significant decrease Apolipoprotein A1 in level in died neonates at diagnosis with mean ± SD (54.06 ± 0.54) mg/dl compared to after (96h) which decrease with mean ± SD (51.67 ± 0.59) mg/dl (p- value <0.001).
There was +ve significant correlation between Apolipoprotein A1 and APGAR score at first, fifth and tenth minute at diagnosis of neonatal sepsis and after 96 hours.
There was –ve significant correlation between apolipoprotein A1 and I/Tratio, I/M ratio, CSS, HSS and CRP at diagnosis of neonatal sepsis and after 96 hours.