الفهرس 
NEONATAL SEPSIS
Morbidity and mortalityOnly 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 differentiation 64 (CD64).clinical and laboratory findings may help in making a diagnosis. Several acute phase reactants such as C-reactive protein (CRP) have proven helpful in the diagnosis of an ongoing infection, the levels of which increase with the degree of inflammation.
Platelets play a major role in the integrity of normal hematopoiesis and are involved in fibrin formation and deposition. They play an important role in the inflammatory response. Platelet activation and consumption are common in critically ill patients and are associated with poor prognosis. The platelet count is very dynamic; their circulating survival time is approximately 10 days under normal conditions. Thrombocytopenia is at least as common in pediatric intensive care unit (PICU) as in adult intensive care. But there is considerable debate regarding the appropriate evaluation and management of affected infant.
Platelet size and activity are correlated. Mean platelet volume (MPV) is a reflection of platelet size, and consequently platelet function and activation. MPV is routinely studied in complete blood counting. So, it is an important, simple, readily available and cost effective tool.
The aim of this study was to study the changes of platelet count and MPV in neonatal sepsis (NS) and their relation to disease outcome.This study was performed on forty neonates with clinical sepsis, admitted to the emergency department or neonatal intensive care unit of Ain Shams University Hospitals and forty age, sex and weight matched healthy controls. An informed consent was obtained from the legal guardian of each patient or control before enrollment. The study was approved by the Ethical Committee of Ain Shams University.
According to the results of blood culture the patients classified into:
group I: Neonates with proved sepsis.
group II: Culture negative septic neonates.
The incidence of culture positive sepsis was 75%, the most common isolated organism were staph coagulase negative (34.1%) followed by group B streptococcus (GBS) (19.5%) and Kliebsiella (12.2%).
Regarding the hematological indices of CBC between culture positive (group I) and negative (group II) septic neonates, TLC, platelets and PDW were matched. Meanwhile, mean MPV was significantly increased.
Delta changes in MPV were calculated at day 4 (ΔMPV1) and day 28 (ΔMPV 2), ΔMPV was significantly higher in group I (culture negative) than group II.Regarding patient’s follow up, at the end of this study Out of the forty studied septic neonates 17 (42.5%) were died (poor outcome) and 23 (56.5%) were recovered (good outcome).
According to the relation between percentage change in MPV (Δ MPV) and mortalities at ICU, baseline MPV1 as well as Δ MPV1 were significantly increased.
On the other hand, platelet count was significantly low in patients with poor outcome.
As regard the diagnostic power of CD64%: Mean nCD64% expression was significantly higher in patients group compared with the controls. Mean nCD64% was positively related to disease outcome.
As regard CRP levels which is the main conventional marker used in our neonatal intensive care units (NICUs), median CRP was significantly higher in patients compared with the controls. CRP was negatively correlated with platelet count, positively correlated with MPV and nCD64.
As regard the hematological indices of CBC the comparison between the sepsis groups and the control group through day of admission, 4th, 28th days of ICU stay, CBC showed significantly lower. Whereas, I/T ratio was significantly higher in the patients group. Platelets were significantly decreased among septic neonates. Concerning platelet indices; MPV was significantly increased in septic neonates compared with the controls, while no significant difference was detected in PDW or hemoglobin between the two groups.
In this study we found that MPV, DELTA MPV, platelet count and CRP have a prognostic utility to predict disease outcome.
Conclusion: Mean platelet Volume (MPV) dynamics, platelets count, CRP have a prognostic role and could be used in determining several complications in the critically ill pediatric.