الفهرس 
Patients and methodsOnly 14 pages are availabe for public view
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Abstract
Sepsis is a significant cause of morbidity and mortality in the newborn,particularly in preterm, low birth weight infants, despite advances in neonatal care, infections remain common and sometimes life-threatening in neonates admitted to the neonatal intensive care unit (NICU)
Early onset sepsis can occur in the first week of life. It usually is apparent on the first day after birth. This type of infection is usually acquired before the birth of the infant. Premature rupture of membranes and other obstetrical complications can add to the risk of early-onset sepsis. If the amniotic membrane has been ruptured greater than 18 hours before delivery the infant may be at more risk for this complication. Prematurity, low birth weight, chorioamnionitis, maternal urinary tract infection and/or maternal fever are complications that increase the risk for early-onset sepsis. Early onset sepsis is indicated by serious respiratory symptoms. The infant usually suffers from pneumonia, hypothermia, or shock. The mortality rate is 30 to 50%.
In Egypt, a study was conducted in NICUs in Mansoura Hospitals founded that the incidence of suspected neonatal sepsis was 45.9% (357/778) among the admitted neonates.
Despite extensive investigation, no single test meets the criteria that would make it an ideal marker for early diagnosis of sepsis in the newborn. Generally, screening includes a complete blood count with differential and may be accompanied by other adjuvant tests such as a C-reactive protein (CRP) .
CRP was first described in the 1930’s and since then multiple studies have shown elevation of the CRP in several infectious and non-infectious etiologies that share a common background of inflammation or tissue injury.
A blood culture is the gold standard for the diagnosis of neonatal sepsis. However, the long time for results and frequent false-negative culture results due to the small volume of blood samples limit its use for decision making about antibiotic therapy. Therefore, many biochemical markers, hematological indices, and scoring systems are used to help in decision-making about antibiotic therapy in newborns with suspected sepsis.
A great effort to reduce the neonatal mortality rate is put into looking for new reliable biomarkers. Among biomarkers, presepsin could be one of the most promising and reliable biomarker for early diagnosis of sepsisPresepsin (sCD14-st) is a trunked portion of soluble CD14, released by shedding from the surface of many immune cells, such as macrophages, monocytes, and neutrophils, after being stimulated by pathogens.
Presepsin has recently been described as a reliable diagnostic and prognostic marker of sepsis. (Poggi C et al., 2015)
The purpose of this prospective study was to compare presepsin level in neonatal sepsis with CRP level which is the most frequently used marker for neonatal sepsis in Egypt and with CBC results to evaluate presepsin as a potential early diagnostic and a reliable marker for neonatal sepsis in preterm infants.
Our study was carried out during the period from September2017 to January2018 on 50 neonates divided into:-
Patient group: 35 preterm neonates with suspected sepsis admitted to the NICU in Benha university hospital and Benha Children Hospital by age of 6h of age
Control group: 15 healthy preterm neonates .
Blood culture was done for neonates of patient group and according to its result, the cases were classified into:
Proven sepsis group: 16 patients with +ve blood culture.
Probable sepsis group: 19 patients with -ve blood culture.
Levels of presepsin were assessed in these patient and control groups by human sCD 14 st ELISA kit, produced by R&D Systems, Inc. 614 McKinley Place NE, Minneapolis, MN 55413, USA and correlated with the results of CRP and HSS.
The results of this study can be summarized as follow:
For each case a Complete blood count (CBC) was done at admission, C-reactive protein,blood culture and presepsin was done 3times; the first was during 1st day of admission, the second was taken during the 2nd day, and the 3rd was taken during the 3rd day.
•25.7% of cases had a history of prolonged rupture of membranes (PROM), 8.6% withchorioamnionitis ,8.6% with UTI and 8.6 % with Diabetus ,8.6%with fever,5.7%with Antepartum haemorrhge.
•65.7% of cases were admitted for respiratory distress, 14.3% for cyanosis, 5.7% for low poor reflexesas ,8.6%for convulsionsand 5.7 % for lethargy.
•kiebsiella was the most common causative organism in 20% of the patient group , Coagulase negative staphylococc in11.4%, Staphylococcus aureus in11.4% ,Pseudomonas aerogenosa in 2%
,while 54.25 shows no growth.
•CRP percentage and level were found to be significantly higher in patient group than control group as well as in proven sepsis group
than probable sepsis group.
•Presepsin level was found to be significantly higher in patient group than control group as well as in proven sepsis group than probable sepsis group.
•There was no significance difference between males and females for the case and control group
•There was no significant difference in the presepsin level as regard mode of delivery nor onset of sepsis.
•There was significant positive correlation between presepsin level and each of CRP level and Tlc.
•The cut off value for presepsin was 788 pg/ml at which the sensitivity and specificity of presepsin were(100%, 100%) respectively, which were better than those of CRP.