الفهرس 
Neonatal Sepsis
Immunotherapy in neonatal sepsisOnly 14 pages are availabe for public view
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Abstract
Sepsis is a significant cause of morbidity and mortality in the newborn, particularly in preterm, low birth weight infants, despite advances in neonatal care, infections remain common and sometimes life-threatening in neonates admitted to the neonatal intensive care unit (NICU). Early recognition and diagnosis of neonatal sepsis are difficult because of the variable and nonspecific clinical presentation of this condition. It is extremely important to make an early diagnosis of sepsis, because prompt institution of antimicrobial therapy improves outcomes. Despite extensive investigation, no single test meets the criteria that would make it an ideal marker for early diagnosis of sepsis in the newborn. Generally, screening includes a complete blood count with differential and may be accompanied by other adjuvant tests such as a C-reactive protein (CRP). Blood culture is the gold standard for the diagnosis of neonatal sepsis which requires a minimum of 48-72 hours and yields a positive result in only 30-70% of cases and may not be available in all hospitals and affected by blood volume inoculated, prenatal antibiotic use, level of bacteremia and laboratory capabilities. The purpose of this prospective study was to evaluate the incidence of neonatal sepsis in the NICU of TUH and the causative organisms causing sepsis. Our study included 330 neonates that were divided into 2 groups: 1- group I: Sepsis group, it included 145 cases. 2- group II: Non sepsis group, it included 185 controls. All patients in the study in both groups were subjected to the following: Full history taking. Full clinical examination. CBC CRP. Blood culture is conducted to those showing manifestations of sepsis and having risk factors to sepsis. This study demonstrated that: 1. The incidence of neonatal sepsis in our TUH NICU about (43.94%) of the total number of cases in our TUH NICU admitted along one year. 2. Blood culture positive cases represented about (72.41%) of sepsis group. 3. The predominant microorganism among culture positive cases was klebsiella (31.03%) followed by staphylococcus aureus (20%). 4. Most of cases with sepsis show manifestations of sepsis after admission to our NICU (57.93%) of the cases with sepsis while who showed sepsis manifestations before admission was (42.07%) of sepsis cases. 5. The operated sepsis cases represented about (29.66 %) of sepsis group. And the most common microorganism among operated cases who were culture positive was staphylococcus aureus (25.58%) fowllowd by klebsiella (16.28%) . 6. As regard PROM& chorioaminionitis as an important risk factors to sepsis, (22.07%) of sepsis group had history of PROM &about (10.34%) of sepsis group had history of chorioaminionitis. 7. The most frequent clinical manifestation of sepsis was loss of interest for feeding and poor suckling (27.59%) followed by hypothermia(20.69%). 8. CRP is considered acute phase reactant nonspecific to sepsis but highly sensitive.In the present study,CRP had high sensitivity (79 %) specificity (25 %), PPV (79 %) NPV (24%) . 9. Sepsis group showed mortality rate (57.42 %) which is considered high. 10. Higher mortality rate was reported with culture positive cases (66.27%) than culture negative cases (33.73%). 11. Higher mortality rate in culture positive group was seen due to Klebsiella followed by Staphylococus aureus. 12. HB level is significantly lower in sepsis group than non sepsis group (P value <0.001*). 13. Platelets count is significantly lower in sepsis group than non sepsis group (P value<0.001*). 14. WBCS count is significantly higher in sepsis group than non sepsis group (P value <0.001*). 16. There were no significant differences between the 2 groups as regard to gestational age and sex, mode of delivery (P = 0.288 , 0.692 , 0.167 respectively). 17. The mean body weight was significantly lower in the neonates with neonatal sepsis compared to the control group (Mean ±SD = 2.309 ± 0.770, 2.948 ± 0.939 respectively) (P <0.001*). 18. Sensitivity and resistance of the causative organisms to antiiotics was mentioned in discussion.