الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 126 |  |  |
| | | from | 126 | | |
Abstract
Early-onset sepsis is one of the leading causes of neonatal morbidity and mortality worldwide and timely diagnosis is, therefore, of paramount importance.
The earliest signs of sepsis in neonates are often elusive and nonspecific, so a high index of suspicion is needed for early diagnosis.
Early and efficient treatment is crucial for outcome and prognosis in neonatal sepsis cases, leading to frequent administration of empirically selected broad-spectrum antibiotics in high-risk infants.
Sepsis diagnosis in neonates is typically based on a combination of maternal risk factors, hematologic indices, and the judgment of the physician rather than their clinical presentation. Early biomarkers combined with accurate and rapid measurement methods are needed for early diagnosis of sepsis and guidance of the antibiotic therapy.
Several studies have suggested that alterations in cerebral blood flow velocity may be associated with sepsis.
Therefore, studying the neonatal cerebral blood flow and velocities in sepsis is of value to identify any alteration of cerebral circulation.
Monitoring cerebral blood flow velocity can provide valuable insights into the state of cerebral perfusion, so that Doppler Ultrasonography has an important role the assessment of the cerebral blood flow in patients with early-onset-neonatal sepsis (EONS).
In this study, we aimed to explore the diagnostic value of the cerebral blood flow (CBF) velocity in the early-onset neonatal sepsis (EONS).
The study was a prospective observational case-control study conducted over two years from July 2021 to June 2023 in the neonatal intensive care unit (NICU) at Mansheyet El Bakry General Hospital in Cairo.
The study recruited 99 newborns; the (Case group) contained 56 neonates with a diagnosis of EONS, while the (Control group) contained age-matched 43 non-sepsis newborns.
We examined the neonates within 72 hours of birth for those who presented with features of early onset neonatal sepsis (EONS) compared their cerebral blood flow measures to aseptic neonates.
All neonates were subjected to measurement of the peak systolic velocities (PSV), end diastolic velocity (EDV), resistance index (RI) and pulsatility index (PI) by trans-cranial Doppler in the anterior cerebral artery (ACA) and middle cerebral artery (MCA).
Laboratory investigations were done for all neonates including Complete blood count CBC and biomarkers of sepsis: C-reactive protein CRP, Lactate, ABG PH, PCO2, and Base Excess BE.
These measures were compared between sepsis group of the neonates and sepsis-free group. A correlation between cerebral blood flow parameters and laboratory indicators of sepsis was done.
Results of transcranial Doppler showed a significantly lower resistance PI and RI indices, significantly higher EDV, and relatively higher PSV velocities in both ACA and MCA within 72 hours of birth in neonates with EONS compared to the control group of neonates without sepsis, which indicate a generalized increase in cerebral blood flow with a decrease in blood flow resistance as an early response to sepsis.
Among all the parameters studied, sensitivity, specificity, and diagnostic accuracy for RI in both ACA and MCA were the highest in predicting EONS.
The results also showed a strong association between inflammatory laboratory biomarkers and Doppler cerebral blood flow indices in early neonatal sepsis.
Based on the results of this study we concluded that Doppler ultrasonography examination can be utilized to evaluate CBF in the first few hours of birth and can be used as a highly predictive bedside, noninvasive investigation with immediate diagnostic value for early onset neonatal sepsis.