الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Neonatal sepsis is a frequent life-threatening problem in neonatal intensive care units particularly in low birth weightinfants. Early onset sepsis (EOS; sepsis in infant <72 h-old) occurs in 1.5 – 1.9% and late-onset sepsis (Los; onset after 72h of life) in 20%. Coagulase-negative staphycocci, staphaures and fungi are responsible for most neonatal infection. Early diagnosis and treatment of neonatal sepsis are essential to prevent severe life threatening complication. In this era of multi-drug resistance, it is mandatory to avoid unnecessary use of antibiotics to treat non-infected infants. Thus rapid diagnostic test (s) that differentiate infected from non-infected infants particularly in the early newborn period, have the potential to make a significant impact on neonatal care. Candida and aspergillus species are the most commonly isolated organisms. Neonatal candidiasis is a common complication in preterm and low birth weight infants surviving beyond the first 2 weeks of life. Candidemia accounts for 12% to 15% of late onset sepsis episodes in the neonatal intensive care unit (NICU). Risk factors for invasive candidiasis in neonates include prematurity, broad spectrum antibiotics (e.g., third-generation cephalosporin), histamines receptors blockers, post-natal steroids, presence of indwelling catheter, the under development of immune system of premature neonate lacks basic immunologic function.
Summary
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Blood cultures take time and have poor sensitivity, so molecular diagnostic methods using universal fungal PCR primers and species-specific probes have been developed and evaluated for the detection of fungal DNA in clinical specimens with high sensitivity for most pathogenic candida and aspergillus spp. Using extraction of fungal DNA in combination with the real time PCR light cycler system, takes 6 hours, the results were compared by those obtained by conventional methods. The aim of this work isearly diagnosis and treatment of neonatal fungal sepsis to prevent severe life-threatening complications by use of rapid diagnostic test within few hours (Real-time PCR technique).
Our study was conducted on 50 neonates admitted to our Neonatal Intensive Care Unit (NICU) of Menoufia University Hospitals with one or more risk factors predisposing to fungal infection, after 3 days from admission to NICU, with further assessment according to the case.
All the neonates were subjected to:
1. History taking.
2. Clinical examination.
3. Laboratory investigations: Which included:-
- Routine investigation .
- Culture of blood samples for fungal growth.
- Real -time PCR steps. Our study revealed that the detection rate for fungi by fungal culture was only 26%, which is improved to 52% by universal P.C.R. and also improved regards to aspergillus detection to 44% by P.C.R. for aspergillus and there was significant statistical difference (p value <0.001*) of using universal P.C.R. for fungi over classic fungal culture. Universal P.C.R. revealed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of
Summary
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[100%, 64.86%, 50%, 100% and74.0%] respectively. Also real time P.C.R. for aspergillus shows significant statistical difference (p value = 0.005*) and revealed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of [76.92%, 67.57%, 45.45%, 89.29% and 70.0%] respectively. Compared to culture, the real time PCR demonstrated, high sensitivity 100% and high negative value for ruling out neonatal fungal sepsis.
Incidence of fungal infection was more in consangious female preterms with median gestational age of 35.5 weeks and weight of 1.95Kg and so, low birth weight and prematurity remains the major neonatal risk factors.
PROM was found in a higher percentage as major maternal risk factor.
Positive cases appear more with ventilatory support and CPAP as endotracheal tubes help in colonization of fungi
The risk of fungal infection increased with long duration of central venous line (mean duration for positive cases was 13 days) despite non significant difference found between both + ve and – ve cases.
Incidence of fungal infection were more in Positive cases were more presented with poor suckling (69.2%), weak Moro (61.5%), hypoactivity (80.8), seizures (19.2%), irritability (15.4%), various degree of respiratory distress, hepatomegaly (53.8%) and also splenomegaly (46.2%).
Our study showed that pneumonia, prematurity, multiple congenital anomalies, late onset sepsis and H.I.E. were found as higher diagnosis with + ve cases.
Our study showed that positive cases found to have median total leucocyte count of 17.5/mm3 and platelets of 84.5/mm3 and elevated C.R.P. levels.
Summary
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Our study showed that (80.8%) of positive cases was under fluconazole therapy for median duration 10.0 days and 50.0% of positive cases improved with antifungal therapy, 26.9% failed with antifungal drugs.
Our study showed that (69.2%) of positive cases by universal P.C.R. were survived and this was a high rate of survival.