الفهرس 
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Abstract
Neonatal sepsis is a systemic condition of bacterial, viral, or fungal origin that is associated with hemodynamic changes and other clinical manifestations and results in substantial morbidity and mortality (Wynn et al., 2014). Sepsis has been classified as either early-onset or late-onset depending on the age of onset and timing of the sepsis episode. Clinical manifestations of early-onset infections usually appear within the first 72 h of life. Some clinicians define early-onset infections, especially those due to group B Streptococcus (GBS), as infections occurring at less than 7 days of age. Early-onset infections are acquired before or during delivery and usually represent vertical mother-to-infant transmission (Wynn et al., 2014). The risk factors of early onset sepsis are classified into major risk factors: ruptured membranes > 24 hrs. Maternal fever (100.4F or 38 C), chorioamnionitis, and sustained fetal heart rate >160/min and multiple obstetric procedures. Minor risk factors: ruptured membranes > 12 hrs. Foul smelling liquor, maternal Fever > 99.5F (37.5 C), low APGAR < 5 at 1 min, < 7 at 5 min, Prematurity, multiple gestation and maternal UTI. Presence of 1 major or 2 minor risk factors indicate a high risk for early onset sepsis (Shane et al., 2017). CD64, a high affinity receptor that binds monomeric IgG, is normally expressed by monocytes and weakly on resting neutrophils. The expression of neutrophil CD64 (nCD64) is considered to be a very early phase of the host’s immune response to bacterial infection, increasing about one hour after invasion. It is stimulated by inflammatory cytokines, then increases in a graded manner. nCD64 expression remains stable for more than 24 h. The development of flow cytometric technology (FCM) has made it possible to measure nCD64 quickly and precisely with minimal blood volumes. Interest in nCD64 for detecting serious bacterial infections is increasing rapidly (De Jong et al., 2015). Aim of the work : The aim of the study was to determine the role of CD64 expression as a neutrophil surface marker for early diagnosis and treatment of neonatal sepsis within first 6 hours of life in babies with risk factors of early onset sepsis. Materials and Methods : This is a cohort study measuring the level of CD64 in 50 newborns with maternal and fetal risk factors within 1st 6 hours of life. * This study included 50 babies with maternal or fetal risk factors. * CD64 was done for all babies in the first 6 hours of birth. * on second day of life clinical follow up for signs of infection,CRP and CBC were done. On the basis of CRP,CBC and clinical examination,the babies were stratified into : Infected group : included 30 babies with elevated CRP and hematological and clinical signs of infection. Non_infected group : included 20 babies with normal CRP and normal hematological finding with no clinical signs of infection Results: By analyzing and processing the data of CD64 in first 6 hours of life, we found that its level is higher in infected group than non-infected group. However, there was no statistically significant change of CD64% between first 6 hours of life and second day among the infected cases. As regard validity of CD64 in differentiating neonates with early onset sepsis, the current study demonstrated that, the area under ROC curve in differentiating cases with early onset sepsis is good (AUC=0.922, P=0.003) , cut off point was 20.7 yielding sensitivity of 93.3% , specificity of 80% and total accuracy of 88%. Conclusion: Neutrophil CD64 expression was demonstrated to be a promising and reliable diagnostic marker in early onset neonatal sepsis in the first hours of life in babies with risk factors. Additionally, CD64 level had a positive correlation with CRP, thus it is beneficial to use both of them in diagnosis and follow of suspected cases. The presence of risk factors in mother carry high probability of early onset sepsis and so CD64 estimation early in first hours of life could help us to start antibiotics early for infected cases and to withheld antibiotics for non-infected cases to avoid unnessary use of antibiotics.