الفهرس 
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Abstract
Neonatal sepsis is a clinical syndrome resulting from the pathophysiological effects of severe bacterial infection in the first month of life.
The World Health Organization (WHO) estimates that 1 million deaths per year (10% of all under-five years mortality) are due to neonatal sepsis and that 42% of these deaths occur in the first week of life.
Neonatal sepsis is an important cause of morbidity and mortality despite the major advances in the management.
Sepsis is characterized by temperature instability, increased oxygen demand, apnea, intercostal retraction, weak pulse, delayed capillary refill, hypotension, tachycardia, irritability, lethargy, hypotonia, abdominal distension and may progress to septic shock and DIC.
Hematological indices, a cute phase reactants, protein markers, and cytokines have been extensively examined as adjunctive tests for diagnosis of sepsis.
There are many lines for treatment of neonatal sepsis including supportive therapy, antibiotics, exchange transfusion, immue therapy as IVIg and G-CSF. There is increasing trials to detect recent lines of treatment of neonatal sepsis to decrease its mortality and morbidity.
Melatonin, an endogenously produced indamine formed in adult humans, but only minimally so in neonates, is a highly effective antioxidant and remove free radical. Melatonin is believed to work by electron donation to directly detoxify Reactive oxygen species as hydroxyl radical and hydrogen peroxide. Another action of Melatonin also is to stimulate many antioxidative enzymes such as, glutathione peroxidase, and glutathione reductase and superoxide dismutase.
This study was done in The Neonatal Intensive Care Unit of Menoufia University Hospital from November 2015 to May 2016 to clarify the role of Melatonin in treatment of neonatal septicemia.
Our study was carried out on 40 neonates divided into 2 groups:
group 1 (intervention): 20 neonates received Melatonin as single dosage through a Ryle at night with the circadian rhythm to augment its action in addition to the conventional antibiotics.
group 2 (control): 20 neonates received the conventional antibiotics only.
Before giving the medications, both groups were subjected to good history taking perinatal, natal and postnatal history then adequate clinical exam also investigations done were blood culture as a gold standard for diagnosis of sepsis. And a baseline CBC including (TLC, I/T Ratio, HGB level, platelet count) and estimation of hi sensitive CRP.
24 and 72 hours after giving Melatonin and antibiotics for group 1 and antibiotics only for group 2, we measure CBC and CRP and compare the results of both groups with each other.
In our study we found that increased frequency of sepsis with low birth weight and prematures than full term and normal birth weight neonates.
In our study we found that there were no increased frequency of sepsis as regard age, sex and mode of delivery in both groups.
In our study we found the most frequent presentation was respiratory distress.
In our study we found that mostly in both groups (32.5%) of neonates had negative blood culture, while (67.5%) had positive blood culture and the most frequent isolated organism was Klebsiella.pneumoniae (20%).
As regard hs CRP there was no significant difference between group 1 and group 2 before melatonin administration while 24 and 72 hours after, the hi sensitive C-reactive protein decreased in both groups and was significantly lower in group 1 than group 2.
As regard TLC there was no significant difference between group 1 and group 2 before melatonin administration while 24 and 72 hours after, the TLC decreased in both groups and was significantly lower in group 1 than group 2.
As regard I/T Ratio there was no significant difference between group 1 and group 2 before melatonin administration while 24 hours and 72 hours after melatonin administration, there was also no significant difference. I/T ratio showed little improvement in both groups with no significant difference.
As regard HGB level there was no significant difference between group 1 and group 2 before melatonin administration while 24 and 72 hours after, the HGB level increased in both groups and was significantly higher in group1 than group 2.
As regard platelet count there was no significant difference between group 1 and group 2 before melatonin administration while 24 after melatonin administration there was also no significant difference between both groups. And 72 hours after melatonin administration, the platelet count increased in both groups and was significantly higher in group 1 than group 2.
During our work, no cases died from the intervention group while one case of the control group developed septic shock and DIC then died.
So the improvement was significantly higher in the intervention group (melatonin) than the control group.
Our data provided evidence that melatonin is not only a hormone but also could be used as an antioxidant and a free radical scavenger.
Finally, we could conclude that Administration of melatonin in the treatment of neonatal sepsis in addition to the conventional antibiotics is associated with better prognosis and outcome in both preterm and full term neonates.