الفهرس 
Subjects and MethodsOnly 14 pages are availabe for public view
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Abstract
Sepsis in neonates hospitalized in the NICU is a global problem and is a significant contributor to morbidity and mortality. The clinical signs are non-specific and indistinguishable from those caused by a variety of neonatal noninfectious disorders.Early recognition and diagnosis of neonatal sepsis are difficult but is extremely important because accurate institution of antimicrobial therapy improves outcomes. Isolation of bacteria from a central body fluid (usually blood) is the gold standard and most-specific method to diagnose neonatal sepsis. Among natural antimicrobial peptides, human beta defensins (HBDs) are important contributors to host immunity. HBDs are small cationic peptides classified inside the higher group named defensins and have been described four types in detail until now, HBD1, HBD2, HBD3 and HBD4. The expression and release these peptides depend on the defensins and cell type and stimuli (cytokines/chemokines and microorganisms) being constitutive or inducible regulated.In this study we selected HBD-2 to test its value in the diagnosis of early-onset neonatal sepsis cases by using ELISA. The present study also aimed to evaluate its association with the different demographic, clinical and laboratory data .This study was carried out on 120 patients; 30 fullterm neonates suspected clinically as EONS patients, 30 preterm neonates suspected EONS patients and 60 apperantly healthy control group. All patients were subjected to complete history taking, thorough clinical examination and laboratory investigations including: CBC, blood culture, CRP and HβD2.In our studied The most prominent signs of EONS were poor suckling, mottled skin, , poor moro, lethargy, respiratory distress ,fever and abdominal distension.PROM more than 18 hours was the most important risk factor of neonatal sepsis.The risk of early onset sepsis increases with decreasing birth weight and gestational age.The most common isolated organisms were gram negative organisms mainly Klebsiella, followed by E-coli.A high statistical significant difference was shown between studied cases and controls as regards HB,WBCs, CRP and platelets count.The mean HBD-2 expression in neonates with sepsis was significantly higher than those in the control group.We found that there was difference in HBD-2 expression between full term neonates and preterm neonates but the difference was not significant.HBD-2 expression had a significant positive correlation with CRP level.ROC curve shows area under the curve for HBD-2 greater than area under the curve for CRP.For HBD-2 expression, In full term neonates the Cutoff value was ≥1.08 and AUC was 0.94. In preterm neonates the Cutoff value was ≥1.14and AUC was 0.941. For HBD-2 expression, In full term neonates sensitivity was 99% and specificity was 97% while in preterm neonates sensitivity was 98% and specificity was 94%. We concluded that the enhanced expression of HBD-2 is more sensitive and more specific compared to CRP.We may recommend that neonates should be regularly investigated for detection of serum HβD2 for early diagnosis of early onset neonatal sepsis to begin the prophylactic antibiotics to lessen and prevent associated disastrous complications of early onset neonatal sepsis.