الفهرس 
Overview of PrematurityOnly 14 pages are availabe for public view
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Abstract
The early onset neonatal sepsis is most consistently defined as
occurring in the first 3 days of life and is caused by bacterial pathogens
transmitted vertically from mother to infant before or during delivery. It
is one of the important contributing factors to mortality and morbidity in
neonates. It is usually distinguished by bacteremia, meningitis, and
pneumonia. It has been linked to neonatal death, hearing impairment,
seizures, and neurodevelopmental abnormalities or delays.
The signs and symptoms are nonspecific in the early stages of
neonatal sepsis. It can be confused with many other conditions that may
occur in this age period that may be non-infectious and have a more
favorable outcome than sepsis. In the era of multi-drug resistance, a
definite and early diagnosis of neonatal sepsis is challenging for avoiding
its fatal outcomes and improving the prognosis of patients.
Blood culture is the gold standard for the diagnosis of neonatal
sepsis. However, its positivity rate is low and is affected by the volume of
blood inoculated, prenatal antibiotic use, level of bacteremia, and
laboratory capabilities. Therefore, the diagnosis of sepsis is usually
difficult and can result in a delay in treatment or the unnecessary use of
antibiotics.
CD14 is a pattern recognition receptor for bacterial molecules,
namely lipopolysaccharides (LPS) from Gram-negative bacteria and
peptidoglycans together with lipoteichoic acid from Gram-positive
bacteria. It mediates the transduction of the endotoxin signal via the tolllike
receptor-4, which leads to the release of various cytokines, promoting
the activation of a systematic inflammatory response.
Summary
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There are two forms of CD14: membrane-bound CD14, which is
expressed on inflammatory cells such as monocytes and macrophages,
and soluble CD14, which is produced by the shedding of the membrane
form in the plasma. Cleavage of soluble CD14 by plasma proteases
generates a 13 kDa fragment known as presepsin (P-SEP). P-SEP is
generated as a part of the body’s response to bacterial infection.
The study was conducted on 56 preterm neonates, who were divided
into 3 groups: group 1 consisted of 16 preterm neonates with cultureproven
EOS, group 2 consisted of 20 preterm neonates with probable
EOS, and group 3 consisted of 20 preterm neonates serving as a control
group.
For all neonates, the following were performed:
1- History taking (to detect risk factors of sepsis).
2- Clinical examination (to detect clinical signs of sepsis).
3- Laboratory investigations:
Complete blood count with differential count and peripheral
blood smear examination.
CRP quantitative assay.
Liver function tests (ALT, AST, albumin, TSB, DSB, PT, and
PTT).
Renal function tests (urea and creatinine).
Serum electrolytes (Na, K, and Ca).
Capillary blood gas.
Blood culture.
Human presepsin using ELISA technique.
Summary
156
The results of the present study were as follows:
There was no significant difference regarding the sex, gestational
age, birth weight, length, head circumference, mode of delivery,
delivery place, parity, and maternal age between the culture proven
EOS, probable EOS, and control groups.
There was a significant decrease in Apgar at 1 and 5 minutes in the
proven sepsis and probable sepsis groups in comparison with the
control group.
There was no significant difference between the culture proven
EOS and probable EOS groups regarding the neonatal and maternal
risk factors for EOS and the clinical signs of neonatal sepsis.
There was no significant difference in liver functions, renal
function tests, serum electrolytes, or capillary blood gases.
Regarding CBC parameters at baseline, there was a significant
decrease in platelet count in proven EOS compared to control
groups. The I/T ratio was significantly higher in the proven EOS
group compared to the probable EOS and control groups. The
RDW was significantly higher in the probable EOS group
compared to the proven EOS and control groups.
Regarding CBC parameters at follow-up, the hematocrit level was
significantly higher in the probable EOS group than the proven
EOS group.
Regarding sepsis scores and sepsis biomarkers at baseline, there
was a significant increase in the SNAP II score, the Rodwell score,
and the P-SEP in both proven and probable EOS groups compared
Summary
157
to control groups. However, there was no significant difference
with regard to CRP between the sepsis groups and the control
group.
Regarding sepsis scores and sepsis biomarkers at follow-up, there
was a significant increase in SNAP II score and P-SEP in proven
EOS groups compared to probable EOS groups. However, there
was no significant difference as regard CRP between proven EOS
and probable EOS groups.
Regarding correlation between P-SEP and other sepsis parameters
at baseline, there was a strong positive correlation between P-SEP
level, SNAP II score, and Rodwell score. However, P-SEP at
baseline did not correlate with hemoglobin, RDW, TLC, I/T ratio,
platelet count, or CRP.
In terms of correlation with other sepsis parameters at follow-up,
there was a strong positive correlation between P-SEP and SNAP
II score and CRP. However, P-SEP at follow-up did not correlate
with hemoglobin, RDW, TLC, or platelet count.
Multivariate binary logistic regression of independent predictors of
EOS revealed that the P-SEP was the only independent predictor
for EOS.
Blood culture results were positive in 44.4% of all sepsis cases.
The gram-negative infection was 50% of positive cultures, and the
gram-positive infection was 43.7% of positive cultures