الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Inspite of the use of potent antibiotics and intensive supportive
care , sepsis is still a major cause of morbidity and mortality during
the neonatal period (Adriaanse , 1996) .Bacterial sepsis leads to
many metabolic disturbances including disturbances in glucose which
is the main source of energy for brain growth and metabolism, insulin
hormone which plays a central role in glucose homeostasis and lactate
which is an intermediary in carbohydrate metabolism (Bailey et al.,
1990) .
The aim of this study is to clarify the effects of sepsis on blood
glucose, lactate and insulin in newborn infants with bacterial sepsis .
The study was carried out on (60) newborns who were classified into
(4) groups :-
- Group (1) included (20) septicemic fullterms proved by positive
blood culture .
- Group (2) included (10) healthy fullterms .
- Group (3) inclued (20) septicemic preterms proved by positive
blood culture .
- Group (4) included (10) uncomplicated preterms.
All of them were appropriate for gestational age with no history of
maternal diabetes or other endocrinal diseases .
Each newborn was subjected to the following investigations:
1- Hematological study: full blood picture with special emphasis
on hematological scoring system.
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2- C-reactive protein assay by quantitativemeasure .
3- Blood culture .
4- Blood gases .
5- Blood glucose
6- Serum insulin .
7- Serum lactate .
It is to be noted that all previous investigationswere performed
once for control group and twice among septicemic babies . The first
one on clinical presentation and the second after complete clinical and
laboratory cure . Also it is to be noted that dead patients were
excluded from the study .
In our work , the number of septicemic patients with a
hematological score ~ 3 were 38 cases , whereas 2 septicemic
neonates out of 40 patients were false negative i.e. had positive blood
cultures but their hematological score were less than 3 . The
sensitivity of HSS as an indirect test for early prediction of neonatal
sepsis was 95%, its specificitywas 100% , positive predictive value
was 100% while the negative predictive value was 90.9% .
As regard to CRP, it was sensitive in 85% of cases , its
specificity was 100% , the positive predictive accuracy was 100%
while the negative predictive accuracy was 76.9 % .
Gram-negative organisms are still the predominant causes of
bacterial sepsis as they represented 67.5% of our cases.
As regard to blood glucose, out of 40 septicemic newborns, 16
cases had hypoglycemia i.e. (40%) (9 preterms and 7 fullterms) no
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hyperglycemic cases were reported. Only one preterm of our patients
and two fullterms presented with neurological signs in the form of
seizures and corrected by intravenous glucose administration. There
was no significant correlations between hypoglycemia and poor
feeding. Hyperinsulinemia was not detected in our cases i.e,
hypoglycemia was not due to hyperinsulinism. The proposed
mechanism (s) of sepsis associated hypoglycemia include increased
metabolic rate, altered glucose production and increased insulin
sensitivity (Pildes, 1986) .
The normal insulin level has a very wide range (20-180
picomol/ml). So it is difficult to define hypoinsulinism or
hyperinsulinism unless the normal for the same individual was
previously known (Burtis and Ashood , 1994) .Also it was difficult
for Fitzegerald et aL , (1992) to define hyperinsulinismin their study
on the effect of neonatal sepsis on carbohydrate metabolism, they
compared both serum insulin and insulin : glucose ratio of the
septicemic group with serum insulin and insulin : glucose ratio of the
control group .
In our study , there was significanthypoinsulinismin both fullterm
and preterm septicemic newborns . This hypoinsulinismwas corrected
after treatment . The insulin : glucose ratio was statistically
insignificant among fullterms when comparison was made between
septic and control groups. Also in the same septic group before and
after treatment . The same was observed in preterms .
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The mean values of serum lactate in septicemic groups (fulltenns
and preterms ) were significantly higher than that of control groups
(fullterms and pretenns) . Also, the mean values of serum lactate in
septic groups (fullterms and preterms ) before treatment were
significantlyhigher than that after treatment.
The causes of hyperlactemia include decreased oxygen delivery to
the tissues that will lead to (hypoxic anerobic metabalism ) or
impaired mitochondrial function i.e. impaired oxygen use. The causes
of decreased oxygen delivery are respiratory (,\..P02) , cardiovascular
(hypotension) and severe anemia. In our study , we found neither
hypoxemia , nor hypotension . Anemia was found but it was not
severe enough to interfere with the oxygen delivery to the tissues .
Accordingly , the elevated lactic acid might be due to a defect in
mitochondrial function with impaired oxygen use .
We can conclude that:
1- Hematological scoring system was found to be a highly
valuable test for early prediction of neonatal sepsis .
2- C-reactive protein is of value for diagnosing septicemia at a
level of 13 mg/l or more, lesser values (6.5 mg/d) , interpreted
as a positive test by the routine qualitative method is not
diagnostic of septicemia.
3- Gram-negative bacilli are still the dominant organisms causing
neonatal sepsis .
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4- Hypoglycemia is a common problem among septicemic
neonates . The asymptomatichypoglycemicneonates are much
more commonthan symptomatichypoglycemic neonates.
5- Serum insulin levels were significantlydecreased among septic
groups than control groups .
6- Serum lactate levels were significantlyincreased among septic
groups more than control groups. This hyperlactemia can be
explained by impaired oxygen use due to mitochondrial
inhibition in septicemic cases .