الفهرس 
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Abstract
Neonatal sepsis, sepsis neonatorum and neonatal septicemia have been used to describe the systemic response to infection in newborn infants. Previously, it was considered to involve mainly bacterial infections. However, it is now known that a great variety of microbes other than bacteria may be responsible.
Neonatal sepsis is the single most important cause of neonatal deaths in the community, accounting for over half of them. If diagnosed early and treated aggressively with antibiotics and good supportive care, it is possible to save most cases of neonatal sepsis.
The incidence of sepsis neonatorum is from 1 to 8 cases per 1000 live births and 1 per 250 live premature births.
Sepsis is the sixth leading cause of death among neonates and the eighth cause of death for infants through the first year of life.
There are three different types of neonatal sepsis according of onset of sepsis which are: early-onset sepsis, late-onset sepsis, and late late-onset sepsis.
The initial choice of drugs is depending on knowledge of the probable pathogen based on perinatal history, including maternal symptoms, cultures or instrumentation, local pathogens with their susceptibilities, the nature of the illness, and the unit policy, a combination of aminoglycosides and ampicillin is the most widely used, some replace third generation cephalosporin instead of aminoglycosides especially in neonates having meningitis.
Patient and method:-
The present study was carried out on 100 newborn infants (65males and 35 females), from the NICU of Menoufiya University and NICU of Elshohada hospital during a period from March 2015 to March 2016.Their age was ranged from 1st day to 10th day of life.
The studied neonates divided into two groups:
group 1: - includes 50 neonates at risk of neonatal sepsis started their treatment with Ampicillin and Cefotaxime.
group 2: - included 50 neonates at risk of neonatal sepsis started their treatment with Ampicillin and gentamicin.
NB. The distribution of neonates in each group was empirically
Inclusion criteria:
All neonates admitted to NICU and they are at risk of neonatal sepsis including:
1-Neonates with prematurity.
2- Neonates with premature rupture membrane > 18 hours.
3- Meconium aspiration syndrome.
4-Neonates with maternal pre-eclampsia.
5- Neonates with maternal choroamnioitis.
6-Infants of Diabetic Mothers (IDM).
7- Neonate with maternal urinary tract infection.
Exclusion Criteria:
Neonate with proved sepsis
Neonates with surgical problems.
Neonates with inborn errors of metabolism.
The studied groups were subjected to:
1. Detailed history taking.
2. Complete general examination including anthropometric measurements and Ballard score.
3. investigations including
Laboratory investigation:
Complete blood count (CBC).
C-reactive protein (CRP) on admission and 2nd (CRP) after 48hrs from starting antibiotic.
Arterial blood gases (ABG).
Blood culture for bacterial infection.
Radiological investigation:
Chest x ray.
Data management and statistical analysis.
This study revealed that:
Regarding to Neonatal and maternal characteristics of the studied groups:
In our study there was no statistically significant difference between group 1 & group 2 regarding age, sex, weight, maturity, and anthropometric measurement (p<0.00(
Also in our study there was no statistically significant difference between group 1 & group 2 regarding PROM, co-morbidity, mode of delivery, consanguinity, and history of meconium aspiration .
on the other hand we found that 12 mothers in group 1 and only 3 mothers in group 2 had maternal fever and the difference was statistically significant (p=0.012), which increased risk for neonatal sepsis in group 1 other than group 2 (which appear in our follow up to both groups).
As regard to Resuscitation history of the studied groups :
In our study there is no statistically significant difference between both groups regarding resuscitation history including Apgar score at 1 minute and 5 minute, so resuscitation history not included as risk for sepsis.
As regarding to laboratory investigation:
In our study there is no statistically significant difference between both groups regarding to Hb, HCT, WBCs, and bilirubin so not included as risk for sepsis, On the other hand the only hematological factor with statistically significantly difference between both groups in our study is platelet (p=0.019), so thrombocytopenia is included as risk factor for neonatal sepsis.
As regard to clinical examination and clinical sepsis score:
In our study clinical sepsis score was decreased in group 2 (ampicillin & gentamicin) versus group 1 (ampicillin & cefotaxime) with statistically significant difference (P =0.016).
Also in group 2 there is statistically significance difference regarding clinical sepsis score pretreatment and post treatment (p=0.009).
from both results we conclude that group2 treated by (ampicillin& gentamicin) improved clinically more than group1which was treated with (ampicillin & cefotaxim As regarding to CRP of the studied groups:
In our study we found that:
In group 1 CRP was +ve in 30cases (60%) on admission then after treatment for 48hours the next CRP (post treatment) with (ampicillin &cefotaxime) was +ve in 38 cases (76%).
In group 2 CRP was +ve in 31 cases (62%) and post treatment with (ampicillin & gentamicin) CRP was +ve in 25 cases (50%).
So this result also indicate that ampicillin &gentamicin better than ampicillin &cefotaxime in empirical use for child at risk of sepsis.
In our study: CRP result is parallel to blood culture result (CRP was +ve in 61% of our cases, also +ve blood culture in 61% of cases) which indicate high sensitivity of CRP in detection to neonatal sepsis, so we should give empirical antibiotics without waiting result of culture & sensitivity.
As Regarding to culture and sensitivity of the studied groups :
Our study shows that culture with no growth in 39 % of cases and growth was in 61% of the total number, where the most common organism isolated were Escherichia coli (13.1%) and Klebsiella pneumonia (13.1%), also Escherichia coli were the most predominant in group 2 so more sensitive to (gentamicin and ampicillin).
Regarding culture sensitivity our study shows that 43% of organisms sensitive to cefotaxime in group 1versus 18% in group 2, and 27% sensitive to gentamicin in group 1 versus 57% in group 2, so there is
more sensitivity to gentamicin in both groups rather than sensitivity to cefotaxime.
So finally from our study we can conclude that ampicillin and gentamicin is better than combination of ampicillin & cefotaxime as empirical use in neonate at risk of sepsis.