الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Neonatal sepsis remains a major clinical problem in neonatology , with high morbidity and mortality .The host defense against infections is immature in the newborn infant , and this makes the child more susceptible to invasive infection .
Unfortunately there is no single diagnostic test which can reliably diagnose sepsis in the newborn , therefore many diagnostic tests are utilized to diagnose or confirm sepsis .
PCT is a 14 – kDa protein encoded by the calc – 1 gene along with calcitonin and katacalcin , studies of its behavior in patients with sepsis have led to the proposal that it may be a useful marker of systemic bacterial infection with greater sensitivity than acute phase protein such as C-¬¬¬¬¬¬¬¬¬ reactive protein .
In this work we tried to evaluate PCT serum level as a marker of neonatal sepsis.
This study was conducted on 61neonates diagnosed as having sepsis by the clinical presentation & laboratory. They were admitted to the neonatal unit (NICU) at El Helal Hospital, Sohag city, Egypt ;). It was approved by the Institutional Scientific and Ethical Committee, and written informed consents were obtained from the parents.
patients were subjected to full history taking , thorough clinical examination and laboratory investigations including CBC with differential , CRP, blood culture and sensitivity and measurement of PCT .
In our study Fifty one patients (83.6%) were proved to have sepsis by positive blood cultures.
In this study there were higher serum levels of PCT1 and CRP1 observed in neonates with EONS than those in neonates with LONS with significant statistical difference for PCT1 (P = 0.036)but with no statistically significant difference for CRP1 (P = 0.3768 ).
When evaluating neonates with suspected late-onset sepsis, we found that PCT1 had sensitivity, specificity, PPV, NPV and AUC values of 87%, 50%, 41.3%, 90.58% and 0.93 respectively at a cut-off point of >4.9ng/ml.
Results of this study show that, there were statistically significant decrease of values of both PCT2 and CRP2 (6.58±3.88 & 26.42±14.27 respectively) when compared with results of PCT1 and CRP1 (17.4 ± 6.58 & 54.46±32.4 respectively) (P < 0.001) in both EONS and LONS groups.
The results supported the use of procalcitonin serum level in neonatal sepsis as a reliable and quick diagnostic and prognostic parameter that helps early detection and follow up of the neonates with sepsis .
For clinical use in the future the decision to initiate antibiotic treatment might be based on positive results of procalcitonin and such strategy would probably reduce the unnecessary use of antibiotic therapy.
CONCLUSIONS
In conclusion, the findings of the present study confirm that the serum levels of PCT is more reliable marker than the serum levels of CRP in the early diagnosis of neonatal sepsis. However both of them are reliable in the evaluation of the response of the disease to the antibiotic therapy. The benefit of measuring serum PCT routinely in the diagnosis and follow-up of neonatal sepsis, is that it reduces the hospital costs and reduces unnecessary overuse of antibiotics with their probable side effects and development of drug resistance. Such a benefit might support a wider acceptance of the test in the routine practice.
Based on the results of the present study, we recommend that the commencement of antibiotics in newborn infants should be based on the PCT results on the day of their admission to the NICU.