الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Summary
Neonatal sepsis is a life threatening emergency with a high morbidity and mortality. Initial signs of neonatal sepsis are often slight and non-specific making early diagnosis is so difficult. Diagnosis can be confirmed by blood culture, but may be delayed up to 72 hours or more. So, several studies have searched for parameters that could be useful in the early and accurate diagnosis of neonatal sepsis.
The present study was perform to evaluate the use of serum Amyloid A (SAA) as an early diagnostic tool for neonatal sepsis and to compare the results obtained to those of and other hematological parameters.
The study included 60 neonates, 40 with suspected sepsis (suspected group), and the other 20 were healthy matched neonates serving as control group.
According to the blood culture results, the suspected group (n=40), was subdivided into… confirmed sepsis subgroup (n=31) with positive blood culture and clinical and biochemical evidence of sepsis and clinically septic subgroup (n=9) with negative blood culture
All neonates were subjected to full history taking, clinical examination and laboratory investigations including, complete blood count with differential count (CBC), C-reactive protein (CRP), blood culture and sensitivity test, and SAA level measurement by ELISA. Also
All investigations were done for the suspected group when sepsis was first suspected.
The most clinical presentations among the septic group were poor suckling, poor Moro, lethargy, and respiratory distress.
As regard the blood culture results, Gram negative organisms were predominant in 67.7% of cases, mainly klebseilla, which represented 35.5% of all the isolated organisms.
In the early onset sepsis the gram negative organisms was (55%) while gram positive organisms was (20%).
In the late onset sepsis the gram negative organisms was (50%) while gram positive organisms was (30%).
The mean value of SAA in confirmed sepsis subgroup was (77.1+15) μg/ml, compared to clinically septic subgroup (4.5+1.32 ) and control group (2.7+1.8) μg/ml, and this was proved highly statistically significant.
The SAA level was more elevated in the Gram negative group (72.2+24.3) μg/ml, than the Gram positive group (66.5+19.6) μg/ml.
The mean level of the SAA protein in the group with early onset sepsis was (82.98+56.69) which was significantly higher than group with late-onset sepsis (41.46±36.10µg/L) this indicates that SAA elevate early and more in early onset sepsis than late onset.
Also by comparing the hematological parameter in groups with early onset sepsis and late onset we find that, there was no significantly deference for the mean hemoglobin (Hb) level, and platelets count (Plat). as for total leukocytic count (TLC), the mean level in group with late onset sepsis was (18.02+8.39) which significantly higher than group with early-onset sepsis (14.1+5.59). As for I/T ratio the mean level in the group with late onset sepsis was (0.310+0.126) which significantly higher than group with early-onset sepsis (0.202+0.124), which indicates that TLC and I/T ratio elevate lately and more in late onset sepsis, and it is bitter used as a markers in late onset sepsis than early onset.
A comparison between the diagnostic sensitivities of laboratory investigations when sepsis was suspected revealed that SAA was positive (>10μg/ml) in 93.5% cases and is the most sensitive marker (93.5%) in comparison with TLC(80%), I:T ratio(80%) and platelets count (40%) in diagnosis of neonatal sepsis,
Also its specificity was high (88.9%) in comparison with TLC (53%), I/T (75.3%), and platelets count (34%).
The positive predictive value (PPV) of SAA in this study was (96.7%) which was higher than that of TLC (63.16%), I: T ratio (87.2%), and PLT count (37.50%).
SAA had the highest negative predictive value (NPV) which was (80%), while The NPV of I: T ratio was (77%), TLC was (72.73%), and that of PLT was (35.71%).
from the results, we can concluded that SAA seems to be an early, highly sensitive and specific marker for the diagnosis of neonatal sepsis at the first suspicion of infection,
The Quick and reliable use of SAA in early diagnosis of neonatal sepsis can be useful in early initiation of antibiotic treatment, duration, response, and outcome after therapy.