الفهرس 
Neonatal sepsisOnly 14 pages are availabe for public view
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Abstract
Sepsis in newborns is a common fatal disorder affecting 1.1-2.7% of all newborns.
In spite of extensive research and development in understanding and treatment of neonatal sepsis, sepsis continues to be a major source of morbidity and mortality in the neonatal population.
Neonatal sepsis (NS) remains a diagnostic burden problem by showing minimal initial symptoms of subtle character, nonspecific manifestations, and diagnostic pitfalls. The clinical course can be fulminate and fatal if treatment is not commenced promptly. It is therefore crucial to establish early diagnosis and initiate adequate therapy.
The rapid diagnosis and management of infection are heavily dependent upon clinical assessment. Blood culture may take up to 7 days for results and may be inconclusive, thus there is an urgent need for a specific marker to aid in early diagnosis of sepsis as live saving measure.
In the past few years, attention has been directed to leukocyte cell surface antigens as diagnostic markers of neonatal sepsis, One marker that has shown particular promise as an early marker for infection is neutrophils surface cluster of designation 64 (CD64)
This study was designed to confirm the role of neutrophil CD64% as an early marker of sepsis at Ain Shams University Hospital`s NICUs, and to determine the best early predictor panel of markers that can be used conventionally.
This study conducted at Ain Shams university hospitals NICUs over an 8-months period and included a total of 175 sepsis evaluations were performed on 121 neonates, the majority of neonates (71 out of 121) had only one evaluation, (50 out of 121 had 2 evaluations) and only 2 patients had more than 2 evaluations, they are classified into three groups: Group 1a: Documented sepsis group (n= 17), in whom sepsis was proved both clinically and by blood culture result, group 1b: Clinical sepsis group (n= 74) sepsis was proved only clinically with Clinical symptoms or signs of sepsis, in which bacterial culture result is not yet available, And group2: Control group (n=30) which included newborns with no symptoms or signs of infection.
The clinical features used to identify patients at risk for sepsis included two or more of the following features which include (symptoms of respiratory compromise, cardiovascular compromise and metabolic changes).
After taking an informed consent, all the studied individuals were subjected to full history taking (through medical records) and complete clinical examination. Blood samples were collected for determination of serum highly sensitive CRP, CBC, CD64 expression and blood culture.
As regard the comparative statistics conducted between the three studied groups there were a statistically highly significant increase (p < 0.01) in levels of Neutrophil CD64 in both documented sepsis (group 1a) and clinical sepsis (group 1b) when compared to the healthy controls (group 2), but no statistically significant difference was found when group 1a compared with group 1b.
As regard CRP levels which is the main conventional marker used in our NICUs, the comparative statistics revealed that there were highly statistically significant increase (p < 0.01) in serum of both documented sepsis (group 1a) and clinical sepsis (group 1b) when compared to their matched controls (group 2). Additionally, it revealed a highly statistically significant increase (p < 0.01) in serum levels of CRP in group 1b when compared with group 1a alone.
As regard the correlation statistics between the different parameter, a statistically significant positive correlation (rs=0.248, p < 0.05) between CRP levels and neutrophil CD64 levels in clinical sepsis (group 1b).
In this study we also conduct ROC curve analysis which revealed that CD64 percent <42% was predictive of “no growth” blood culture results. While percent >42% was predictive of an ultimate clinical and/or culture diagnosis of infection with a sensitivity and specificity of 86% and 93.3%, respectively. Positive and negative predictive values were 97.5% and 68.3%, respectively.
The diagnostic performance of each of CD64 and CRP alone and the combination of them was assessed, and we observe that the best efficacy 93.4% can be achieved from this combination with Specificity 100%, PPV 100% , Sensitivity 91.2% and NPV 78.9%.
from all the results done in our study and the extensive combinations and correlations and the ROC analysis with the calculated area under the curve for each parameters of CBC (I/T ratio, ANC, TLC, PLT, absolute monocyte count), CRP, CD64 intensity and CD64 % and lastly the multi regression analysis and the calculated Z score, we can summarize that the best early predictor markers of neonatal sepsis in our study is the combination of CD64% with CRP followed by CD64% alone as a univariante test which showed better diagnostic performance over all other conventional parameters studied.
Furthermore by using the regression equation which include the two early predictor markers, clinicians can predict neonatal sepsis in suspected neonate at a very early stage hence beginning proper and early antibiotic treatment aiming for saving newborns’ life.
In addition to early predictive power of CD64% over the other conventional parameters, it became evident from this study comparative statistics that it has a good prognostic power and can be used as a good follow up marker in neonatal sepsis, additionally it is evident from statistical analysis and case reports that its level increases with the severity of the disease and it decreases with the recovery and proper treatment and is not affected by surgery.
The CD64 percent is a useful and inexpensive test for improving the diagnosis, follow up and management of hospital patients with sepsis. It can be readily performed by clinical laboratories. The CD64 percent can be easily performed in Ain Shams Hospital flowcytometery lab within one working shift. A 7-day-a-week testing schedule will result in some additional expense but will be more than offset by the expected cost savings.