الفهرس 
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Abstract
This study included 90 neonates: group I including 60 neonates with clinically sepsis and group II including 30 neonates apparently neonates with no evidence of sepsis as control group. The clinical sepsis group were selected from the neonatal intensive care unit of El-Minia Obestetric and Pediatric University Hospital.
TLC was a high statistically significant increase in group I comparing with group II (11540± 4932.84 vs 4926.66± 698.43/mm3, P value <0.001 ). Hb was a high statistically significant decrease in group I when compared with group II (14.22 ± 2.58 vs 16.14 ±1.38 gm/dl, P value <0.001). Platlets were a high statistically significant decrease between group I and group II (196.380±94.230 vs 267.330± 53.170/mm3, P value =0.001). Negative CRP was a high statistically significant difference between group I and group II (28.3% vs 100% , P value <0.001).
Blood culture results and common microorganisms in group I were 46.7% negative and 53.3% positive blood culture (staphylococcus aureus 11.7%, staphylococcus epidermidis 8.3%, Ecoli 8.3%, enterobacter 6.7%, kelebsiella 5%, streptococcus pyogens 3.3%, non haemolytic streptococcus 3.3%, staphylococcus saprophyticus 1.7%, pesudomonous 1.7%, proteus 1.7% and candida 1.7%).
The level of procalcitonin in group I was higher than in group II (157.73± 41.22 vs100.93±4.11 pg/ml, P value <0.001). There was a positive sighnificant correlation between procalcitonin level, TLC and CRP ( P value= 0.049)( P value< 0.001). But, procalcitonin was a negative sighnificant correlation with platlets ( P value= 0.018).
Serum apelin was higher in group I than in group II (1992.1± 469.04 vs 1151± 112.63ng/ml, P value < 0.001 ). There was a positive sighnificant correlation between apelin and procalcitonin level (P value <0.001). Also apelin was a positive sighnificant correlation with TLC (P value 0.023). But, apelin was a negative significant correlation with platlets (P value= 0.009).
The level of apelin in negative blood culture cases was highly significant difference with control group (1892.5±456.06 vs 1151±110.67 ng/ml, P value <0.001). The level of procalcitonin in negative blood culture cases was highly significant difference with control group (160.17±34.54 vs 100.93±4.04 pg/ml, P value <0.001).
Apelin in group I had a higher sensitivity (100%), a higher negative predictive value(100%), a higher positive predictive value (100%) and a higher specificity (100%) than procalcitonin ( sensitivity 95%, NPV 88.9%, PPV 90.5% and specificity 80%).
Apelin in negative blood culture cases had a higher sensitivity (100%) and a higher NPV(100%) than procalcitonin ( sensitivity 92.8%, NPV 93.7%), but the same in PPV and specificity (100%).Also apelin in positive blood culture cases had a higher sensitivity (100%) and a higher NPV(100%) than procalcitonin ( sensitivity 75%, NPV 78.9%), but the same in PPV and specificity (100%).
Apelin in early onset cases of neonatal sepsis had a higher sensitivity (100%) and a higher NPV(100%) than procalcitonin ( sensitivity 88.89%, NPV 88.2%), but the same in PPV and specificity (100%).Also apelin in late onset cases of neonatal sepsis had a higher sensitivity (100%) and a higher NPV(100%) than procalcitonin ( sensitivity 75%, NPV 83.3%), but the same in PPV and specificity (100%).
Conclusion
1- Although blood culture is a gold standerd for diagnosis of neonatal sepsis ,but we cannot depend on it only.
2- Apelin and procalcitonin are reliable diagnostic markers of neonatal sepsis which have the same diagnostic accuracy.
3- Apelin and procalcitonin are a good marker for early diagnosis of neonatal sepsis but Apelin is more perfect marker than procalcitonin in diagnosis of early neonatal sepsis.
4- The use of apelin and other markers (procalcitonin, CRP, TLC, platlets and blood culture ) collectively yeild the best results for diagnosis of neonatal sepsis.