الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 190 |  |  |
| | | from | 190 | | |
Abstract
Background: Despite advances in antimicrobial therapy and supportive cares, neonatal sepsis is a major cause of death worldwide. In developing countries, many of the more than 14 million deaths of children under five years of age occur during the neonatal period, with sepsis accounting for up to 70% of total mortality for this age group. Newborns and especially preterm infants are probably more prone to oxidative stress as they are exposed to high oxygen concentrations, have infections or inflammation, have reduced antioxidant defense, and have free iron which enhances the Fenton reaction leading to production of highly toxic hydroxyl radicals. Oxygen-derived metabolites, collectively termed reactive oxygen species, are normally produced in aerobic organisms. Oxidative stress is defined as an imbalance between prooxidant and antioxidant forces leading to an overall prooxidant insult.
Objective: This work was designed to assess the efficacy of melatonin as an adjuvant in the treatment of free radical disease in septic preterms receiving melatonin compared to those on conventional treatment through measuring the level of MDA as a marker of oxidative stress and by comparing other clinical and laboratory parameters of sepsis in both groups.
Patients and Methods: The study included 20 males and 20 females with gestational ages ranged between 26 and 36 weeks, 8 delivered vaginally and 32 delivered by caesarean section, Forty septic preterm infants were included and were subsequently randomized by permuted block randomization according to sequence of enrollment into: Melatonin treated (MT): neonates with odd numbers received melatonin. Conventionally treated (CT): neonates with even numbers didn’t receive the medicine.
Results: Melatonin administration decreased the length of stay of septic preterms in NICU and reduced incidence of mortality in melatonin treated septic group(0%), compared to the other conventionally treated septic group(30%). Our study showed no significant difference between both septic groups regarding all laboratory data at time of enrollment and we found that melatonin improved the clinical outcome of melatonin treated septic preterms through improving the sepsis related serum parameters after 72 h of melatonin administration as an adjuvant therapy to septic preterms in comparison to conventionally treated septic group. Baseline MDA levels were significantly elevated after 72 h in CT group, conversely a high statistically significant decrease in MDA levels among MT group after 72 h of melatonin administration, with statistically significant lower MDA levels than CT group after 72 h. These changes are consistent with melatonin’s ability to reduce the peroxidative breakdown of lipids in cell membranes.
Conclusion: Melatonin can be used as an adjuvant therapy in neonatal sepsis guided by it’s ability to improve serum septic parameters, MDA levels and reduced incidence of mortality and length of stay in NICU for septic preterm babies.