الفهرس 
NEONATAL SEPSISOnly 14 pages are availabe for public view
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Abstract
L
ate onset sepsis and necrotizing enterocolitis are major cause of mortality and morbidity in preterm neonates mainly due to immaturity of their innate and adaptive immune system.
Bovine Colostrum is the first milk that mammals produce after parturition, it contains antimicrobials such as lactoferrin and lactoperoxidases, immunological and growth factors.
Our study aimed to asses effect of oral bovine colostrum in prevention of late onset sepsis and necrotizing enterocolitis when used as gut priming in premature neonates as long as neonate can tolerate oral intake.
Our study was conducted on 80 premature neonates below 34 weeks gestational age, Mean gestational age was 32 weeks, admitted at Ain shams university NICUs.
The enrolled patients were subdivided into two groups, Interventional group (bovine colostrum) are infants received bovine colostrum-concentrate as gut priming and Non interventional group (non-bovine colostrum group): which is formed of two groups, Infant formula are infants received formula milk and standard care group are infants received breast milk (donor or own mother milk) whenever available with artificial formula.
For all neonates, history taken and clinical examination done twice weekly for detection of any attack of sepsis or NEC and every attack assessed by hematological scoring system (Tollner and Rodwell), SNAPII scoring system and Bell’s staging for NEC.
For all neonates, laboratory investigations withdrawn includes complete blood count, C-reactive protein, blood culture if sepsis suspected, and peripheral blood mononuclear cells assessed in first 72 hours of life and after one week, to be analyzed for cellular parameters by flow cytometry (CD4 T cells, CD25, Foxp3 T-regulatory cells). Three subsets of CD4+ T cells will be defined according to CD25 staining: CD25-, CD25 low, and CD25 high. All of these cells are important in preterm immune system homeostasis and prevention of sepsis and NEC.
The type of feeding didn’t affect weight increment significantly. The weight increment was 90 (65 – 100) gm and 75.5 (50 – 90) gm in the bovine colostrum group and non-bovine colostrum group respectively.
In this study, neonates who received bovine colostrum were significantly less in feeding intolerance (p-value 0.038) and incidence of NEC (p-value 0.059), there was only one neonate who developed feeding intolerance and there was no single attack of NEC.
Frequency of attacks of late onset sepsis and severity are less in neonates who received bovine colostrum, 3 (9.4%) neonate developed sepsis in bovine colostrum group compared to 10 (20.8%) neonates in non-bovine colostrum group.
Severity of sepsis attack was less in the bovine colostrum receiving neonates showed by lower SNAP II score (p-value 0.027) and the less use of adrenaline/noradrenaline inotropes (p-value 0.015).
Mortality rate was least in neonates who received bovine colostrum as there was no mortality in bovine colostrum group while there were 8 (16.8%) neonates had mortality in non-bovine colostrum group with p-value 0.015.
T-regulatory cells (Treg) are important in preterm immune system homeostasis and prevention of sepsis and NEC. The increased risk of premature infants for inflammatory intestinal complications such as NEC, may be due to a relative lack or imbalance of Treg in the intestinal lamina propria.
There was a significant differences between both groups as regard the FOXP3 expression at the follow up sample (p-value0.027) with Odds ratio 0.804 (95% CI 0.662-0.976), also the difference of change between the initial and follow up sample in FOXP3 expression was significantly different between both groups (p-value0.018) with Odds ratio 0.823 (95% CI 0.691-0.979).
However, Treg values did not differ statistically between the studied groups at the time of initial sample (first 72 hours) nor at the time of follow-up sample (after one week).
Also, we evaluated the individual changes in each group by time; there was significant increase in bovine colostrum / interventional group as regard expression of CD4 +25 T cells in peripheral blood sample with p-Value=0.034.
on the other hand, in non-bovine colostrum group there was significant increase in expression of CD4 +25 T cells with p-Value=0.015 but with highly significant DROP in the FOXP3 expression with p-value 0.005.