الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Summary & Conclusion .
SUMMARY AND CONCLUSION
Several reports have suggested an increased TNF -a and ll..,-6serum
levels in neonatal sepsis. Some authors stated that the levels ofthese
cytokines were related to the severity of the disease and others deny that.
The present study was performed on 62 newborn infants categorized
as follows:
* Twinty four neonates affected by septicemia as proved by positive blood
culture. (group I).
* Twinty three neonates with suspected sepsis, diagnosed by clinical
manifistations, and positive laboratory tests, the blood cultures were
negative (group II).
* Fifteen healthy newborn infants as a control group (group III).
On admission all cases were clinically examined, and all the
required cultures were taken with radiological examination if need, serum
samples for measuring the levels ofTNF-a, ll..,-6and CRP were collected.
Antibiotics were adminstered to neonates in group I and II, another serum
samples were collected after 48 hours from admission for measuring the
levels of TNF-a, ll..,-6 and CRP to study the effect oftreatrnent on their
levels and correlate these levels with the outcome of the disease.
In this prospective study we found that serum levels of both TNF-a
and ll..,-6 are increased in neonates with septicemia early in the course of
the disease. The levels of these cytokines on admission and 48 hours after
Page No. 123
Summary & Conclusion .
are related to the severity and outcome of the illness, so, the levels in non
survivorswere much higher than in survivors.
We observed that, after the start of therapy with antibiotics, both
TNF-o: and IL-6 serum levels decreased concomitantly with the
improvement of the clinical situation within two days. In non survivor
cases, the treatment was not effective and the serum levels ofTNF-a and
IL-6 still as high as before treatment or may even became higher.
We studied the sensitivity and specificity of both cytokines, to
diagnosis septicemia, TNF-a has a 87.5%. Sensitivity and 65.2%
specificity, while, IL-6 has a sensitivity of 91.7% and specificity of73.9%.
When combined with each other a positive test result for both has a
sensitivityof95.8% and a specificity of78.3%.
We detected that CRP also, is a good diagnostic tool specially late
111 the course of the disease, and when it was used in diagnosis of
septicemia in combination with any of the two cytokines, the diagnosis of
septicemia is almost certain, CRP and IL-6 gives us a sensitivity of 100%
and specificity of78.3%, while, CRP with TNF-a gives us a sensitivity of
100%and specificity of73.9%, in diagnosing septicemia.
We concluded that, although the method that we and others have
used to measure TNF-a and IL-6 serum levels is slow for any clinical
purpose in neonates with sepsis, the relationship found between TNF-a
and IL-6 levels and the outcome of the patients suggests that the
development of faster methods for determiningtheir levels could make this
assay an early prognostic indicator of sepsis in newborns.
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Recommendations .
R£CO~ENDATIONS
1. A more extended studies with large number of patients to study and
evaluate the prognostic usefulness of these cytokines in diagnosis of
septicemia.
2. To study the effect of immunotherapy in the form of monoclonal
antibodies against TNF-a and IL-6 in treatment of neonatal sepsis.
3. To combine the TNF-a or IL-6 with CRP as a diagnostic tool of
neonatal sepsis early in the course of the disease to avoid undue loss of
valuable time or abuse of antibiotics.
4. Try to search for faster methods for TNF-a or IL-6 determination to
make these cytokines an early and good prognostic indicator of sepsis in
newborns.
5. To use CRP and HSS for diagnosis and follow up of the disease as they
are a good indicators of septicemia specially late in the course of the
disease.