الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Neonatal sepsis, sepsis neonatorum, and neonatal septicemia are terms that have been used to describe the systemic response to infection in the newborn infant, it is a clinical syndrome characterized by systemic signs of infection and accompanied by bacteremia in the first 28 days of life. It is a common neonatal problem in Egypt and, still remains a significant cause of mortality and morbidity, particularly among very low birth weight neonates and those admitted to NICUs are at a greater risk of developing neonatal sepsis.
An awareness of the many risk factors associated with neonatal sepsis prepares the clinician for early identification and effective treatment, thereby reducing mortality and morbidity. Early diagnosis and treatment of neonatal septicemia may help decrease neonatal mortality. An accurate and timely diagnosis of early onset neonatal sepsis remains challenging to the clinician and the laboratory.
There is no laboratory test with 100% specificity and sensitivity roe the diagnosis, and hence, the search has continued for a reliable test. Blood culture is the gold standard diagnosis for neonatal sepsis. The traditional sepsis work up included various hematological parameters and CRP.
A commonly discussed sepsis biomarker is Soluble Urokinase Plasminogen Activator Receptor (supar) in neonates with risk of infection as a diagnostic indicator for neonatal sepsis.
Also, comparing between soluble urokinase plasminogen activator receptor (suPAR) and other diagnostic parameters of neonatal sepsis (C-reactive protein, micro-E.S.R, clinical score and hematological score.
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This study was carried out in NICU of Menoufiya University hospital during a period of July 2016 and January 2018.
It was conducted on 60 neonates; neonates admitted to NICU with neonatal sepsis appropriate risk criteria. This group included 30 neonates with definite or suspected sepsis and 30apparently healthy neonates collected from neonatal outpatient clinic with no risk factor for infection Served as control group.
All neonates were subjected to history taken laying stress on risk factor and clinical examination searching for signs of early and late onset sepsis.
The following investigations were done:
1. C.B.C. (complete blood count) with differential leucocytic count.
2. C.R.P. (C - reactive protein).
3. Blood culture.
4. Micro-ESR
5. suPAR.
Our study found that, regarding demographic data, all cases were full term babies. There was statistically non-significant difference between the two studied groups concerning consanguinity (p=0.706), sex (p=0.976), mode of delivery (p=0.592).inspite of predominance of cesarean section as mode of delivery (66.7%). and male sex among septic neonates (53.3%) among septic neonates.
The presence of PROM >18 hrs, was statistically significant between the two groups (p<0.001*).Also, significant difference was observed regarding feeding between the groups of participants
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(p<0.005*). The pattern of feeding in infected group was mainly artificial (50%) followed by breast feeding (36, 7%), I.V.F. (13, 3%) and no mixed feeding. While in control group feeding was mainly breast feeding (60%), followed by artificial (26, 7%), mixed feeding (13, 3%), no I.V.F.
Regarding anthropometric measures (weight, length and head circumference), there was no statistically significant difference between the two studied groups.
Statistical analysis of clinical manifestations revealed significant difference (p <0.001)*, Infected group was higher in mean Clinical sepsis score than control group.
Regarding laboratory finding, (56.7%) of Infected group were Positive for Blood culture.The most common organism was group B streptococci (27 %) of positive blood culture infected neonates. Followed by, Klebsiella spp. (19.5%).
Regarding Hematological sepsis score (p <0.001) *and Micro ESR (1st and 2nd hr), (p <0.001)*. The difference was statistically significant. Infected group was higher than control group.
Regarding CRP, the difference was statistically significant. Infected group was higher in mean CRP (1st and 2nd) than control group (p<0.001)* while with 3rd and control the difference was non-significant (p=0.807). CRP has (96, 7%) sensitivity and (83, 33%) specificity.
Regarding suPAR: the difference was statistically significant. Infected group was higher in mean suPAR (1st and 2nd) than control group (p<0.001)* while with 3rd and control the difference was non-significant (p=0.280).
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For sepsis group our study found that ROC curve for suPAR, AUC of suPAR was 0.937 (p < 0.001) with Cut off >9.7 had a high ability to predict infected patients with Sensitivity (86, 67%) and Specificity (93.33 %).
The results of suPAR in our study were correlated with blood culture, CRP, hematological, clinical Sepsis score and micro E.S.R.
Conclusions
Early elevated serum suPAR levels were prominently related to the severity of neonatal late-onset sepsis.
The level of suPAR in the survivors of the sepsis group was significantly decreased as time went by, and the difference was statistically significant on the 7th day compared with the 1st day.
The results of suPAR were significantly correlated with CRP, micro -E.S.R., hematological Sepsis score and clinicalSepsis score .
Micro ESR has highest diagnostic value with (100 %) sensitivity and (100 %) specificity (p <0.001*). followed by, Clinical sepsis score with with (96.67 %) sensitivity and (93.33 %) specificity (p <0.001*), then CRP with (96.7%) sensitivity and (83.33 %) specificity (p <0.001).
suPAR has (86.67%) sensitivity and (93.33%) specificity(p <0.001*). Followed by hematological Sepsis score with (86.67%) sensitivity and (83.33%) specificity (p <0.001*).
Soluble urokinase plasminogen activator receptor (suPAR), would be advantageous for neonatologists to differentiate infected from non-infected patients. This could lead to a saving in cost because extensive bacteriological and viral studies would then be restricted to the infected group.
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Taking in consideration that, Serial determination may aid diagnosis of neonatal sepsis, and suPAR should always be interpreted in combination with clinical findings in newborns with infections.
However, it cannot discriminate bacterial from viral infections and also its utility for monitoring the response to treatment is questioned. Thus the efficacy of this simple test as preliminary procedure to identify neonates at risk is quite good and can be recommended for neonatal centers.