الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Neonatal pneumonia is a serious respiratory infectious disease with a high rate of case fatality in developing countries despite the tremendous improvement in medical care. Late onset neonatal sepsis usually presents with septicemia and pneumonia after 7 days of age. Clinical features of sepsis are non-specific in neonates and a high index of suspicion is required for the diagnosis. Accurate diagnosis of pneumonia is important for measuring the burden of the disease, implementing appropriate preventive or treatment strategies and developing more effective interventions. CRP is a key marker of inflammation within the clinical practice. Upon production serum CRP levels rise up to 50.000 fold from baseline, doubling every 8 hours and peaking approximately 42 hours after the initial stimulus. The excessive constituents of blood in the systemic circulation such as drugs, hormones, and proteins will outflow to saliva so saliva compromise pooled constituents from the blood and the constituents that are locally produced in the mouth with this unique context saliva can serve as an effective indicator of both local and systemic biological activity. The rise of saliva usage in clinical research is due to the advantage that it can be collected noninvasively and this is safer and more feasible than drawing blood in neonates. A few promising studies showed that salivary CRP is a promising candidate as it has shown correlation of salivary levels with plasma. Platelet volume indices are a group of parameters which are inexpensive and derived from routine blood work up. Mean platelet volume is the most accurate measure of the size of platelets and is inversely associated with platelet count as larger platelets are more reactive and an early increase in MPV is an early marker of platelet activation. The aim of our study is to assess the rule of salivary CRP and MPV as diagnostic markers in late-onset neonatal pneumonia. Our study was a case control study carried out at Neonatal Intensive Care Units (NICUs) Pediatric Department Tanta University Hospitals. This study included 60 full‐term neonates, divided into 2 groups as follows: group (a): included 30 neonates with late-onset neonatal pneumonia and; group (b): included 30 healthy control neonates. Inclusion criteria Full‐ term infants of both genders from age of 7 days until age of 28 day of life admitted to Tanta University NICU with clinical features of lateonset neonatal pneumonia. Exclusion criteria: Neonates with other inflammatory conditions other than pneumonia And those who received antibiotics before admission were excluded from the study group. All healthy neonates who showed no symptoms, signs or risk factors for infection that follow-up in our outpatient clinic and matched the pneumonia group in age and gender were prospectively enrolled in the control group. The serum CRP level for neonates in this group was negative (CRP <10 mg/L). Samples were collected from pneumonia group within 4–12 h of a serum CRP level clinically indicative of pneumonia and prior to the start of antibiotic treatment. All neonates were subjected to the following after an informed consent from their parent and approval from the Ethical Committee of Tanta University Hospital. 1- Thorough history taking and clinical examination and assessment of respiratory distress 2- Chest x ray 3- Cbc 4- Salivary and serum crp The results of the current study demonstrated that: There was no statistically significant difference within the two groups as regard gender, mode of delivery, age, weight, length, head circumference or the presence or absence of maternal illness. Respiratory distress was the most significant presenting symptom, followed by fine crepitation, Diminished air entry in chest examination, cough and fever. Chest X-ray showed pneumonic patches and air bronchogram in the majority of cases, Oxygen support through nasal cannula was observed in most cases while only (10.0%) were mechanically ventilated. Serum CRP values showed significant difference between both groups as will as salivary CRP values which was significantly different between the two groupes. MPV also showed significant difference between both groups. CRP/MPV ratio was significantly higher in the sepsis group compared to the control group. Therefore, it can be concluded that salivary CRP levels were markedly elevated in patients of the pneumonic group more than in those of the control group, Moreover, MPV one of the hemogram parameters showed significant difference between both group (pneumonic and control) with high sensitivity and specificity in predicting late onset neonatal pneumonia. In addition CRP/MPV ratio was significantly higher in the sepsis group compared to the control group. Therefore, this study provides support for further studies on the usefulness of salivary CPR, MPV and CRP/MPV as diagnostic markers for neonatal pneumonia.