الفهرس 
Neonatal SepsisOnly 14 pages are availabe for public view
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Abstract
Sepsis syndrome is SIRS caused by microbial products, viruses or fungi. Neonatal sepsis (NS), sepsis
neonatorum or neonatal septicemia is defined as sepsis which
occurs in the first 4 weeks of life and it is further classified
into EOS which occurs in the first 72 hours and LOS which
starts after 72 hours.
Definite and early diagnosis of neonatal sepsis is
important for avoiding its fatal outcomes and improving the
prognosis of patients especially because symptoms and signs
are non specific. It can be confused with many conditions
that may occur in this age period which may be non
infectious and has more favorable outcome than sepsis.
An accurate inflammatory marker with high diagnostic
sensitivity, specificity and NPV for neonatal sepsis would be
a valuable tool for therapeutic decision-making and
avoidance of unnecessary use of antibiotics. Currently used
methods in diagnosis have many obstacles ranging from poor
sensitivity in case of using blood culture or IT ratio to non
specificity in case of depending on CRP.
CD14 is present in macrophage, monocyte, and
granulocyte cells and their cell membranes, and it is said to
be responsible for intracellular transduction of endotoxin
signals. Its soluble fraction is present in blood and is thought
to be produced in association with infections. It has been
previously reported that presepsin is produced in association
with infection and that it is specifically expressed in sepsis.
Summary
141
The aim of the study was to study levels of presepsin
and cellular expression of CD14 in neonates with sepsis
including those with associated suspected genetic disorders
and to correlate between their levels and CRP levels in those
patients. We also aimed to evaluate the value of these
biomarkers in the discrimination between infectious and
noninfectious inflammation and to determine which
biomarker is better in the early diagnosis of bacterial sepsis.
The current study included forty nine neonates
admitted to the NICU in the Obstetric and Gynecological
Department of Ain Shams University Hospitals, in addition
to twenty one apparently healthy age and sex matched
neonates serving as healthy controls taken from either the
maternity ward or admitted to NICU for non septic causes. A
first level follow up was done after 3-5 days from the initial
workup for 19 patients and a second one was done after
another 5 days for 9 patients. The study was conducted
during the period between October 2013 and May 2014. The
laboratory work was done in the Clinical Pathology
Department, Ain Shams University Hospitals and
Immunogenetics Department, National Research Center.
All subjects under study were subjected to full history
taking from hospital charts, thorough clinical examination
and the following laboratory investigations: CBC, CRP,
blood culture, presepsin level measurement and flow
cytometric analysis for surface expression of CD14 (CD14
MFI and CD14%). Results of this study revealed the
following:
Summary
142
1- There was a statistically significant increase of presepsin
when the comparison was held between: group 1 and group
2, blood culture positive patients and controls, clinically
septic patients and controls, patients with EOS and controls,
patients with LOS and controls. While median values of
presepsin showed no significant increase between: blood
culture positive and negative patients, blood culture negative
patients and controls, clinically septic patients and clinically
not septic ones, clinically not septic patients and controls,
patients with LOS and those with EOS, noting that the higher
value is in the former group in each comparison.
2- As regards CD14 MFI, it was statistically significantly
increased when the comparison was held between: group 1
and group 2, blood culture positive patients and controls,
blood culture negative patients and controls, clinically not
septic patients and controls, clinically septic patients and
controls, patients with EOS and controls, patients with LOS
and controls. The differences between median values of
CD14 MFI were insignificant between: blood culture positive
and negative patients, clinically septic patients and clinically
not septic ones, patients with LOS and those with EOS.
3- Regarding CD14%, the differences in its median values
were statistically insignificant among all different groups’
classifications.
4- As for CRP, its median values showed a statistically
significant increase when comparison was done among:
group 1 and group 2, blood culture positive patients and
controls, clinically septic patients and controls, patients with
Summary
143
LOS and controls. While median values of CRP showed no
significant increase between: blood culture positive and
negative patients, blood culture negative patients and
controls, clinically septic patients and clinically not septic
ones, clinically not septic patients and controls, patients with
LOS and those with EOS, patients with EOS and controls,
with the higher value being in the former group in each
comparison.
5- Correlation studies revealed that there was no statistically
significant correlation between presepsin and other
laboratory parameters, except for the negative correlation
between it and Hb. Also, no correlation was found between
CRP and any of presepsin, CD14 MFI nor CD14%.
6- The cut off value that gives the best sensitivity and specificity; for presepsin it was 1807.5 pg/ml, for CD14 MFI it was 539.49 MFI and for CD14% it was 36.85%.