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Abstract The perinatal period is associated with an increased incidence of thromboembolic complications, which may occur in both the maternal and fetal circulation in otherwise normal and healthy adults and fetuses (Malida, et al; 2002). Remarkable haemostatic alteration occurred in neonates with severe anoxia and sepsis (Dube, et al; 1989). In sepsis, the physiological anticoagulant mechanisms are impaired by various mechanisms. The protein C system is dysfunctional because of low levels of zymogen protein C, downregulation of thrombomodulin and endothelial protein receptors, and low levels of free protein S caused by acute phase-induced high levels of C4b binding protein (Marcil- levi,2005). Protein C, because of its central role in haemostasis, play an integral role in the host response to infection. Protein C depletion, resulting from increased consumption, degradation, and/or decreased synthesis, is characteristic of sepsis and had been shown to predict morbidity and mortality (Shorr, et al; 2006). The pathogenic mechanism of hypoxic hepatitis most often proposed has been a sudden and profound reduction in systemic blood pressure, leading to a reduction in hepatic blood flow with subsequent hypoxia or anoxia of hepatocytes (Reginald, et al; 2000). Most cases of neonatal hepatitis are a result of systemic disease. sepsis caused by systemic and extrahepatic bacterial and viral infection must always be considered when hepatitis is present in a newborn. Gramnegative bacterial infection are especially important causes of sepsis in Summary 83 newborns and infants and requires immediate appropriate therapy (Behrman and kliegman; 2004). The aim of this study is to clarify the effect of critically illness of newborns with elevated liver enzymes (AST and ALT) levels on the physiologic inhibition system of coagulation (PISC) including protein C and protein S. 38 patients of critically ill newborn with elevated liver enzymes (AST and ALT) levels. admitted to NICU of Benha children hospital. As well as twenty clinically normal newborns, age and sex matched, served as control group. Subjects were classified as followed 1- Group I (hypoxic group): Included 17 newborns who had the following criteria: · The 17 newborns included 8 full tern and 9 preterm baby. And also 9 male and 8 female baby. 2- Group II (Septicemic) group :included 21 newborn characterized by presence of neonatal sepsis. 3- Group III (Control group) included twenty clinically normal newborns. The results of this study showed significant marked decrease in the levels of protein C and protein S in the Studied cases, compared to the control group (p < 0.001). sixety of cases developed disseminated intravascular coagulation and died, 42.1% developed rectal bleeding, 47.4% developed necrotizing enterocolitis, 34.2% developed haematuria, 42.1% developed haematemesis, 34.3% developed intracranial haemorrhage and 50% developed convulsion. Summary 84 The most important and significant finding was that there were negative correlations between both protein C and Protein S levels compared to the liver enzymes levels. We also reported that the highest values of liver enzymes and the lowest values of protein C and protein S were observed in newborns who had developed thermboembolic complications and died. |