الفهرس 
NEONATAL SEPSISOnly 14 pages are availabe for public view
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Abstract
epsis in neonates hospitalized in the NICU is a global
problem and is a significant contributor to morbidity and
death. The clinical signs are non-specific and indistinguishable
from those caused by a variety of neonatal noninfectious
disorders.
Early recognition and diagnosis of neonatal sepsis are
difficult but is extremely important because prompt institution
of antimicrobial therapy improves outcomes. Isolation of
bacteria from a central body fluid (usually blood) is the gold
standard and most-specific method to diagnose neonatal sepsis,
but it requires days and its sensitivity is frequently low.
A new biomarker, Presepsin or sCD14-ST is proposed in
the field of sepsis. CD14 is a glycoprotein expressed on the
surface membrane of monocytes/macrophages (mCD14) and
serves as a receptor for complexes of lipopolysaccharides (LPS)
and LPS binding protein (LPBP). Upon binding of LPBP
complexes CD14 activate TLR4-specific pro-inflammatory
signaling cascade thereby starting the inflammatory reaction of
the host against infectious agents. The complex of LPS-LPBPCD14
is released into the circulation by shedding of CD14
from the cell membrane yielding soluble CD14 (sCD14).In this study sCD14 was utilized to assess its value in the
diagnosis of early-onset neonatal sepsis (EONS) using enzymelinked
immunosorbent assay (sCD14, ELISA kit).
The study was carried out on 60 full term neonates; 40
with suspected sepsis and 20 healthy neonates as controls. All
neonates were subjected to complete history taking, through
clinical examination and laboratory investigations including:
CBC, blood culture, CRP and sCD14 level.
The most prominent signs of EONS were poor suckling,
mottled skin, respiratory distress, capillary refill time < 3 sec
and bleeding. PROM more than 18 hours occurred in 50% of
cases as a risk factor of neonatal sepsis, Apgar score at 1 and 5
minutes had a median value of 1.5 and 5 respectively among
neonates with suspected sepsis. The most common isolated
organisms were gram negative organisms mainly E.coli,
followed by gram positive organisms.
A statistical significant difference was shown between
studied cases and controls as regards Hb, WBCs count and a high statistical significant difference was found between the
two groups as regards I:T PMN ratio, CRP and platelets count.
The level of sCD14 was significantly higher in neonates with
suspected sepsis than the control group, and it was also higher
in culture positive neonates than culture negative neonates.
Moreover, the level of sCD14 was significantly higher in neonates with gram negative bacterial septicemia than those
with gram positive bacterial septicemia.
The ROC curve done to assess the diagnostic
performance of the different haematological markers showed
area under the curve for CRP greater than that for sCD14 and
I:T ratio. As regard sCD14, it had a cut-off value of ≥ 9 ng/ml
with sensitivity 92.5% and specificity was100%. sCD14 is
considered to be a reliable and advantageous marker for the
diagnosis of early onset neonatal sepsis (EONS). sCD14 level ≥
9 ng/ml should raise the suspicion of neonatal sepsis.