الفهرس 
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Abstract
Neonatal sepsis is a clinical syndrome characterized by systemic signs of infection accompanied by bacteremia in the first month of life.
It is classified as early-onset neonatal sepsis (occurring within the first 48-72 hours of life) and late-onset neonatal sepsis (occurring after the first 48-72 hours of life). It is one of the leading causes of mortality and morbidity worldwide.
Neonatal sepsis can be diagnosed by blood culture which is gold standard but it is time consuming and has limited sensitivity.
Ferritin is an iron-storing protein., in inflammatory processes, a great production of this protein occurs, inducing a decrease in serum iron, believed to minimize the availability of iron to microorganisms. So ferritin in critically ill patients may be elevated, Elevate serum ferritin is associated with several inflammatory conditions such as sepsis and multiorgan dysfunction syndrome (MODS).
C Reactive protein (CRP) is an acute phase reactant produced in the liver and a frequently used marker in diagnosis of bacterial infection in neonates. It has a half –life of 24 to 48 hours. But as it takes 10 to 12 hours to respond to an infection, it is unreliable.
IL-6 is a proinflammatory cytokine produced by monocytes and macrophages activated by bacterial infection. IL-6 can be detected in blood earlier than CRP during the course of bacterial infection.
Interleukin 6 (IL-6) is a highly sensitive marker and C-Reactive Protein (CRP) is a more specific marker for the diagnosis of neonatal sepsis. So, the combination of IL-6 and CRP are the best predictors of neonatal sepsis.
Procalcitonin PCT, a prohormone produced by the thyroid gland in response to bacterial infections, has also shown to have a quick turnaround time and a high diagnostic accuracy for EONS.
The aim of this study was to evaluate the diagnostic value of Serum Ferritin, IL-6, CRP and Procalcitonin as markers in early onset Neonatal Sepsis and to correlate these markers with different clinical and laboratory data of sepsis in newborn.
This was a case-control study that was conducted at Neonatal Intensive Care unit (Ain Shams Pediatrics Hospital and Shoubra General Hospital) on neonates in their first 3 days of life. They were divided into two groups 20 were clinically suspected cases of neonatal sepsis and the other 20 were matched normal healthy neonates without any major clinical or laboratory evidence of Sepsis that are taken as controls.
The results of our present study can be summarized as follows:
The prevalence of PROM, maternal infection during labor, and the need for ventilation were higher in the neonatal sepsis group, with 30.0%, 30.0%, and 35.0% rates, respectively, compared to 0.0%, 0.0%, and 0.0% in the control group.
The median of CRP for control group was 2.4 (1.1 – 3.5) and it was 16.2 (12.6 – 27.6) for cases Group, and this was highly statistically significant.
The median of PLT for control group was 254 (214 – 339) and it was 185.5 (143.5 – 243) for cases Group, and this was statistically significant.
Regarding the General examination, there were highly statistically significant difference between Control group and cases group regarding Hypo/hyper active (P-value < 0.01).
Regarding the Respiration there were statistically significant difference between Control group and cases group regarding Apnea (P-value = 0.035) and Respiratory distress (P-value = 0.025).
Regarding the CVS, there were highly statistically significant difference between Control group and cases group regarding Poor perfusion (P-value = 0.008) and Prolonged capillary refill (P-value = 0.008).
Regarding the GIT, there were statistically significant difference between Control group and cases group regarding Abdominal distension (P-value = 0.017).
Regarding the Neurological examination there were highly statistically significant difference between Control group and cases group regarding Irritability (P-value = 0.008).
There were 9 (45.0%) cases were Positive Blood Culture and 11 (55.0%) were Negative Blood Culture.
There were 45.0% of the Cases had a Positive Blood Culture, including three cases that were Klebsiella, one case that were E. coli and two cases that were CONS.
The median of Serum ferritin for Control group was 272.45 (121.75 - 364.4) and it was 775 (503.95 - 827.5) for Cases Group, and this was highly statistically significant.
The mean of Procalcitonin for Control group was 146.48 ± 50.2 and it was 1537.07 ± 582.74 for Cases Group, and this was highly statistically significant.
The mean of IL6 for Control group was 16.94 ± 4.5 and it was 254.62 ± 73.86 for Cases Group, and this was highly statistically significant.
The best cut off point for serum ferritin level to differentiate between case and controls was found >336.7 with sensitivity of 90.0%, specificity of 75% and area under curve (AUC) of 87.7%.
The previous ROC curve shows that the best cut off point for IL-6 level to differentiate between case and controls was found >28.7 with sensitivity of 100%, specificity of 100% and area under curve (AUC) of 100%
The previous ROC curve shows that the best cut off point for procalcitonin level to differentiate between case and controls was found >259.4 with sensitivity of 100%, specificity of 100% and area under curve (AUC) of 100%.
There was statistically significant positive correlation found between serum ferritin level and CRP level
There was statistically significant positive correlation found between IL6 and Procalcitonin.