الفهرس 
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Abstract
Material and Methods: Research area: It is basic research that may lead to improvement of the health services, in Asyut University Children Hospital. Research methods and techniques: Medical records of neonates with neonatal sepsis admitted to the Neonatology Unit, Assiut University Children’s Hospital during the period from the 1st of January, 2018 to the 31th of December, 2018. These records were collected and reviewed to choose the cases which fulfilled the inclusion criteria of the study. We designed a structured data collection form to gather the clinical, laboratorial, imaging and therapeutic data from the included records. This form was be designed according to the published guidelines for neonatal sepsis by the American Academy of Pediatrics, 2018. The data was tabulated using Epi Info, version 16.0, and the results will be examined by Chi-square statistics. The magnitude of significant associations will be presented as p-value, Odds Ratios (OR), and 95% confidence interval for the OR. A p-value of less than 0.05 will be considered statistically significant. Type of the study: Descriptive study. Study setting: Neonatology unit, Assiut University Children’s Hospital
Study subjects: Inclusion criteria: All neonates have risk factors of sepsis. All neonates have manifestations of sepsis. Exclusion criteria Infants aged more than 28 days. Results: As regards the distribution of the registered features of the studied 200 cases with neonatal sepsis, data of the present study showed that: 131 cases (65.5%) were males and 69 cases (34.5%) were females. The age of the studied cases ranged from (1 hour -27 days). 118 cases (59% of the studied cases) had an early onset neonatal sepsis, while 82 cases (41% of the studied cases) had a late onset neonatal sepsis. The duration of admission ranged from (3 – 40 days) with a mean ± SD= 15.29 ±7.17. 99 cases (49.5% of the studied cases) were recovered, while 101 cases (50.5% of the studied cases) were died. Regarding rates of the registered risk factors of neonatal sepsis in the studied files of the 200 cases, data of the present study showed that: Asking about the maternal nutrition, the socio-economic state, the prenatal care, weight at birth and the presence of galactosemia were not fulfilled in all the studied files. About rates of the registered clinical manifestations of neonatal sepsis in the studied files of the 200 cases, data of the present study showed that: All the clinical manifestations of neonatal sepsis were examined and registered in files of the studied 200 cases. Regarding rates of the registered investigations for neonatal sepsis in the studied files of the 200 cases, data of the present study showed that: CSF analysis was done for only 20 cases (10% out of the studied cases), all of them had positive results for bacterial meningitis susceptibility (neutrophilic pleocytosis). Blood culture was done for all the studied cases, in 57 cases (28.5%) out of them the causative organisms were detected, i.e E.coli was detected in 5 cases(8.8%), H influenza was detected in one case(1.8%), Klebsiella was detected in 11 cases (19.3%), MRSA was detected in 4 cases(7%), Staph aureus was detected in 17 cases (29.8%) and Streptococcus was detected in 19 cases(33.3%).No growth was found in the reminder 143 cases (71.5%).Repeated blood culture was done for 13 cases (9.1%) only out of the143 cases with negative blood culture results. Blood culture for anerobic infections was not done for all the studied cases including those with negative results of blood culture for aerobic infection (143 cases). Urine culture was performed for just one case (0.5%).Local site cultures as BAL, skin swab or stool culture were not done for all the studied cases. Diagnostic tests for viral and fungal infections were not done for all the studied cases. Arterial blood gases analysis was not done for 52 cases (26%).Echocardiography was not done for 75 cases (37.5%).About rates of CSF culture and radiologic investigations registration in files of the 20 cases with clinically suspected meningitis proved by positive CSF analysis (neutrophilic pleocytosis), data of the present study showed that: CSF culture was not done for all the 20 cases whom subjected to CSF analysis which showed positive results for bacterial meningitis susceptibility. Regarding cases with positive CSF analysis (20 cases), 3 cases (15%) were not subjected to transcranial ultrasonography, 8 cases (40%) were not subjected to head CT scanning, while 17 cases (85%) were not subjected to head MRI. Regarding rates of the registered lines of treatment which were received by the 200 cases with neonatal sepsis, data of the present study showed that: The antimicrobial therapy was started with empirical nonspecific antibiotics for all the studied cases, then it was based on the blood culture results in cases with positive results (57 cases). The nonspecific antibiotics were given to all the studied cases (200 cases) in appropriate doses but the courses were inappropriate in 24 cases (12%). On the other hand, the specific antibiotics which were given to the 57 cases based on blood culture results were given in appropriate doses but with inappropriate courses in 43 cases (75.5%).Among the supportive therapeutic lines, IVIG was not given to 179 cases (89.5%) out of the 200 cases. As regards rates of the registered supportive therapeutic lines which were received by cases with specific medical situations, the present data showed that: Inotropes and volume supportive measures were not given to 21 cases (25%) out of 84 cases with hypotension or shock. As regards rates of blood culture repetition for one time in relation to the results of the first blood culture for the 200 cases with neonatal sepsis, the present data showed that: Blood culture was repeated once for only one case among 57 cases with positive first blood culture results (1.8%). Also, it was repeated once for only 12 cases out of 143 cases with negative first blood culture results (8.4%). This means that 98.2% of those with positive blood culture results and 91.6% of those with negative blood culture results were not subjected to repetition of blood culture even for one time. Conclusion: Data of the present study revealed multiple defects in recording the risk factors of the studied cases. In addition, registered data revealed neglection of important diagnostic investigations, e.g., CSF analysis was done for only 20 cases, repetition of blood culture for aerobic infection was done for only 13 cases (9.1%) only out of the143 cases with negative blood culture results, blood culture for anerobic infection, CSF culture, local site culture and diagnostic tests for fungal and for viral infection were not performed for 100 % of the studied cases, also, urine culture which was performed for only one case (0.5%) of the studied cases. Arterial blood gases analysis was not done for 52 cases (26%). Echocardiography was not done for 75 cases (37.5%). Regarding cases with positive CSF analysis (20 cases), CSF culture was not done for all of them, 3 cases (15%) were not subjected to transcranial ultrasonography, 8 cases (40%) were not subjected to head CT scanning, while 17 cases (85%) were not subjected to head MRI. The therapeutic regimens which were used for treatment of the studied cases was of inappropriate course in 24 cases (12%) of those whom received empirical nonspecific antibiotics and in 43 cases (75.5%) of those whom received culture based antibiotic therapy and there were defects in the supportive measures, e.g., IVIG was not given to 179 cases (89.5%) out of the 200 cases and Inotropes and volume supportive measures were not given to 21 cases (25%) out of 84 cases with hypotension or shock Recommendation: The present study recommends the following: Improvement of the registration of the risk factors of the patients. In NS, blood culture is the corner stone of diagnosis and treatment so, it is mandatory to repeat it after 48 hours of treatment to detect efficacy of the used antibiotics. NS may be due to aerobic infection, anerobic infection, viral or fungal infections so, blood culture for aerobic and anerobic infection and diagnostics tests for viral and fungal infections is highly significant for diagnosis of NS. On the other hand, there are multiple investigations not only for diagnosis of NS but also for detection of course and complications of the disease, e.g., CSF analysis, urine culture, local site culture, echocardiography and arterial blood gases analysis. cases with positive CSF analysis for bacterial meningitis susceptibility are in need for CSF culture, transcranial ultrasonography, brain CT scanning and brain MRI for diagnosis of the causative organism and detection of possible complications. Finally, for management of NS, we must be stick to a well-known published guideline, implementation of the guidelines of the American Academy of Pediatrics (AAP) will improve both the management and the outcome of children with NS.