![]() | Only 14 pages are availabe for public view |
Abstract Neonatal sepsis: Abacterial infection of the blood in a neonate, an infant younger than 4 weeks of age. Babies with sepsis may be listless, ovely sleepy, floppy, week and very pale. Neonatal sepsis is life-threatening. Neonatal septicemia remains one of the main causes of mortality and morbidity despite the progress in hygiene, introduction of new and potent antimicrobial agents for treatment and advanced measures for diagnosis. It is responsible for 30‐50% of total neonatal deaths in developing countries. Neonatal sepsis can be classified to early, late and very lateonset sepsis. Early onset sepsis in general is the sepsis occurs in the first 72 of life. Early-onset sepsis (EOS) often presents as a fulminant, multi-system illness within 72 hours of delivery and is mainly due to bacteria acquired before and during delivery whereas late onset sepsis (LOS) is due to bacteria acquired after delivery (Nosocomial or community sources) and can present as either a fulminant or a smoldering infection. Vitamin D is a fat-soluble steroid hormone that contributes to the maintenance of normal calcium homeostasis and skeletal mineralization. Vitamin D also has immunomodulatory effects on immune function. It was suggested that it might have a role in the optimal functioning of the innate immune system by inducing antimicrobial peptides in epithelial cells, neutrophils and macrophages. Newborns are more susceptible to infections as both innate and adaptive immune systems are not entirely developed. The relationship between vitamin D deficiency and infections, especially lower respiratory tract infections (RTIs), has been demonstrated in children and newborns. Low cord blood 25-hydroxyvitamin D (25-OHD) levels in healthy newborns were found to be associated with an increased risk of developing respiratory syncytial virus infections during infancy. So the aim of this work was to correlate the levels of maternal and neonatal plasma vitamin D with development of early onset sepsis in full term infants. This study was conducted on 60 full term neonates and their mothers divided into two groups: 1-Patients group: 30 full term neonates and their mothers diagnosed as having sepsis. 2-Controls group: 20 full term neonates and their mothers with no clinical or laboratory evidence of sepsis (healthy neonate). Full history taking, full clinical examination for all neonates included in this study and the following investigations were done to all cases: •Complete blood count (CBC). •C-reactive protein (CRP). •Serum 25-hydroxyvitamin D (25OHD) levels in both neonates and mother. The patient group compromised 30 newborns: 18 males (60%) and 12 females (40%), with mean gestational age of (38.3± 0, 53wks). mean birth weight of (2.8± 0.36 kg). The control group compromised 30 healthy full term newborns: 10 males (50%) and 10 females (50%), with mean gestational age of (38.5±0.67wks), mean birth weight of (3.05± 0.28 kg). In the patient group, 13 (43.3%) neonates were delivered vaginally, and 17 (56.7%) neonates were delivered by caesarian section. In the control group, 13(65%) neonates were delivered vaginally, and 7 (35%) neonates were delivered by caesarian section. The results of our study were: •There were no significant differences regarding infants sex, GA and weight between the sepsis and control groups (P>0.05). •There were significant differences between the sepsis and control groups regarding mode of delivery, season of birth. •There were highly significant differences between the sepsis and control groups regarding Apgar score at 1 min and Apgar score 5 min. •As regard maternal history, there was a highly significant difference between the sepsis and control groups regarding maternal education and history of vit D intake by the mothers. •Regarding the most frequent clinical presentation of sepsis poor suckling was found in about (96.7%) followed by tachypnea (83.3%) then feeding intolerance (80%). •There were a significant difference between patient and control as regard Hb%, TLC, and show a highly significant difference between them as regard PLT. •There were a highly significant difference between patient and control as regard infant and maternal vit D level. •There were a highly significant difference between patient and control as regard CRP. •There were a significant negative colleration between infant vitD level in patient and CRP. •A highly significant positive colleration between infant vit D level and maternal vit D in patient group and a significant positive colleration between infant vit D level and maternal vit D in control group. •There were a highly significant relation between infant, maternal vit D level and season. •ROC analysis of the data showed that the best cutoff neonatal vit D value for the risk of sepsis was 8.74 ng (sensitivity =95.3%, specificity = 95.5%, area under the curve = 0.95 NPV=95.5 and PPV=95.5while the cutoff maternal vit D was 22.02ng (sensitivity = 91.5%, specificity =94.7%, area under the curve = 0.91, NPV=93.5and PPV=95.3) |