الفهرس 
Neonatal sepsisOnly 14 pages are availabe for public view
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Abstract
Neonatal sepsis remains the most common cause of neonatal mortality and morbidity. Diagnosis of neonatal sepsis remains a challenge as it has subtle and different signs and symptoms at different gestational ages.
Although blood culture is the gold standard in diagnosing NS, the search for markers of NS with high sensitivity is ongoing to overcome the drawbacks of blood cultures.
C-reactive protein (CRP), a major acute phase protein, is a member of the pentraxin family and plays a central role in innate and adaptive immunity. Despite the development of new biomarkers, to date CRP is one of the most studied and most used laboratory tests for diagnosis of neonatal sepsis. CRP takes 10-12 h to significantly rise after the onset of infection. As CRP shows an increase in several conditions, it is preferably used in combination with other biomarkers.
A relevant problem in the current clinical approach for sick neonates is the limited availability of simple, safe, noninvasive diagnostic tools with high diagnostic accuracy. Neonatal saliva overcomes many of the hurdles associated with neonatal research and offers investigators a new, exciting, and non-invasive sample source for exploring neonatal biology. CRP is detectable in neonatal saliva and can predict abnormal serum CRP thresholds.
Mean platelet volume is a laboratory value that is defined as the mean volume of a large number of platelets as measured on automated hematology machines.it was observed that MPV increases in infections, sepsis, and thrombocytopenia.
Other certain parameters of complete blood count (CBC) were used as markers of inflammation and infections. The neutrophil-lymphocyte ratio (NLR) is a simple biomarker of inflammation. In addition, platelet lymphocyte ratio (PLR) is also a useful marker of systemic inflammation.
The present study was designed to assess the applicability of salivary CRP, MPV, NLR, and PLR as diagnostic markers in preterm neonates with neonatal sepsis.
The study was conducted on 184 neonates divided into case and control groups.
The case group compromised 92 preterm newborns who were diagnosed as having NS. They were 45 males (48.9 %) and 57 females (51.1%), with mean gestational age of (33.63±1.324weeks), mean birth weight of (2.09±0.335Kg), serum CRP of (54.41±23.621 mg/dL), salivary CRP of (40.94±21.410 mg/dL), MPV of (9.40±1.207 fL), NLR of (2.73±0.410), and PLR of (60.4±7.6).
The control group compromised 92 healthy preterm newborns. They were 43males (46.7 %) and 49 females (53.3 %), with mean gestational age of (34.25±1.364 weeks), mean birth weight of (2.31±0.365 Kg), serum CRP of (6.60±2.174 mg/dL), salivary CRP of (4.23±1.944 mg/dL), MPV of (7.08±0.929 fL), NLR of (1.53±0.169), and PLR of (81.2±34.8).
All patients in the study were subjected to adequate history taking, full clinical examination, CBC including MPV, NLR, PLR, serum CRP with titer, salivary CRP with titer, and blood culture.
There was highly significant increase in case group than in control group regarding TLC count, Neutrophils, serum CRP and highly significant decrease in RBC count, Hb, and platelet count.
In our study, we found that salivary CRP, MPV, and NLR were significantly higher in neonates with sepsis and PLR was not significant in sepsis group.
Summary
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Area under curve (AUC) values Obtained from ROC analysis for salivary CRP, MPV, and NLR were 0.999 (p= <0.001), 0.937 (p= <0.001), and 0.997(p= <0.001) respectively.
In our study, salivary CRP had 98.9% sensitivity, 100% specificity, 100% PPV, 96.8% NPV and 97.28 % accuracy, MPV had 82.6 % sensitivity, 97.8 % specificity, 97.40 % PPV, 84.90 % NPV and 88.6 % accuracy, and NLR had 97.8 % sensitivity, 98.9 % specificity, 98.9% PPV, 97.8% NPV and 97.8 % accuracy.
The diagnostic cut off values for salivary CRP, MPV, and NLR were 8 mg/dL 8.4 fL, and 1.87 9 respectively.