الفهرس 
Coagulation inhibitorsOnly 14 pages are availabe for public view
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Abstract
The perinatal period is associated with an increased incidence of
thromboembolic complications, which may occur in both the maternal
and fetal circulation in otherwise normal and healthy adults and fetuses
(Malida, et al; 2002). Remarkable haemostatic alteration occurred in
neonates with severe anoxia and sepsis (Dube, et al; 1989).
In sepsis, the physiological anticoagulant mechanisms are
impaired by various mechanisms. The protein C system is dysfunctional
because of low levels of zymogen protein C, downregulation of
thrombomodulin and endothelial protein receptors, and low levels of free
protein S caused by acute phase-induced high levels of C4b binding
protein (Marcil- levi,2005).
Protein C, because of its central role in haemostasis, play an
integral role in the host response to infection. Protein C depletion,
resulting from increased consumption, degradation, and/or decreased
synthesis, is characteristic of sepsis and had been shown to predict
morbidity and mortality (Shorr, et al; 2006).
The pathogenic mechanism of hypoxic hepatitis most often
proposed has been a sudden and profound reduction in systemic blood
pressure, leading to a reduction in hepatic blood flow with subsequent
hypoxia or anoxia of hepatocytes (Reginald, et al; 2000).
Most cases of neonatal hepatitis are a result of systemic disease.
sepsis caused by systemic and extrahepatic bacterial and viral infection
must always be considered when hepatitis is present in a newborn. Gramnegative
bacterial infection are especially important causes of sepsis in
Summary
83
newborns and infants and requires immediate appropriate therapy
(Behrman and kliegman; 2004).
The aim of this study is to clarify the effect of critically illness of
newborns with elevated liver enzymes (AST and ALT) levels on the
physiologic inhibition system of coagulation (PISC) including protein C
and protein S.
38 patients of critically ill newborn with elevated liver enzymes
(AST and ALT) levels. admitted to NICU of Benha children hospital. As
well as twenty clinically normal newborns, age and sex matched, served
as control group.
Subjects were classified as followed
1- Group I (hypoxic group): Included 17 newborns who had the
following criteria:
· The 17 newborns included 8 full tern and 9 preterm baby. And
also 9 male and 8 female baby.
2- Group II (Septicemic) group :included 21 newborn
characterized by presence of neonatal sepsis.
3- Group III (Control group) included twenty clinically normal
newborns.
The results of this study showed significant marked decrease in the
levels of protein C and protein S in the Studied cases, compared to the
control group (p < 0.001). sixety of cases developed disseminated
intravascular coagulation and died, 42.1% developed rectal bleeding,
47.4% developed necrotizing enterocolitis, 34.2% developed haematuria,
42.1% developed haematemesis, 34.3% developed intracranial
haemorrhage and 50% developed convulsion.
Summary
84
The most important and significant finding was that there were
negative correlations between both protein C and Protein S levels
compared to the liver enzymes levels.
We also reported that the highest values of liver enzymes and the
lowest values of protein C and protein S were observed in newborns who
had developed thermboembolic complications and died.