الفهرس 
N EONATAL SEPSISOnly 14 pages are availabe for public view
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Abstract
Background: Respiratory viral infections occurring in the neonatal intensive care units can cause significant morbidity and mortality. Testing for viral pathogens is not routinely done in many NICUS, hence, limiting data bout their existence. Furthermore, most reports about respiratory viral infections prevalence in NICUS have focused on outbreaks or prospective surveillance of clinically stable infants, hence widening the knowledge gaps. Many comparative studies concluded that real-time reverse-transcription polymerase chain reaction (RRt-PCR) assays are considerably more sensitive than conventional methods such as viral culture and immunofluresence assays.
Objective: The aim of this study was to estimate the prevalence of respiratory viral infections among neonates with clinical sepsis using multiplex PCR technique.
Methods: This study was conducted on 150 neonates recruited from children hospital NICU of Ain Shams University hospital in the period from January 2015 to December 2016. Neonates included in the study had gestational age 28 weeks or more and had clinical picture of sepsis. Those with Apgar score less than 6 at 5 minutes, major congenital malformations or respiratory compromise secondary to central causes were excluded from the study, blood culture was done on all neonates. Forty neonates with negative blood culture were chosen to do multiplex PCR for eight respiratory viruses from their nasopharngeal aspirates.
Results: Forty neonates were enrolled in this study, 20 (50%) were males with median gestational age was 37 weeks, median postnatal age at hospital admission was 2930 grams. The median duration of infant’s hospitalization was 20 days, 14(35%) were low birth eight, 12 (30%) were preterm babies. Twelve neonates (30%) had early onset sepsis and 28 neonates (70%) had late onset sepsis. Twenty deliveries (50%) were cesarean and 33 (82.5%) of included neonates were born in the hospital. Twelve preterm babies (30%) included in this study. Eight viruses were tested by real-time-multiplex PCR, 5 viruses were positive as following: 4 cases were shown to be HSV (type I); 4 cases infected with rhinovirus; 3 cases infected enterovirus; 3 cases infected with adenovirus; 2 cases infected with influenza virus. There was co-infection with both rhinovirus and influenza virus in one neonate. No cases were positive with HMPV, coronavirus and RSV. The prevalence rate of respiratory viral infections was 16 neonates, (10.6%) among 150 neonates with clinical sepsis and (40%) among 40 neonates with negative blood culture. The demographic data such as gestational age, duration of hospitalization, postnatal age at time of sepsis evaluation and clinical data such as respiratory signs, ventilation need and duration of hospitalization showed no statistically significant differences between positive and negative viral multiplex PCR groups. Regarding laboratory data, elevated liver enzymes concentration were significantly elevated in positive group than negative one.
Conclusion: Viral respiratory infection is not uncommon in neonatal intensive care units. The identification of specific viral pathogens using multiplex PCR is important to limit the unnecessary use of antibiotics and to give specific antiviral therapy. Finally higher liver enzymes could be clue to suspect viral sepsis cases.