الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
Abstract
Neonatal sepsis remains one of the leading causes of morbidity and mortality both among term and preterm infants. Although advances in neonatal care have improved survival and reduced complications in preterm infants, sepsis still contributes significantly to mortality and morbidity among very-low-birth-weight (VLBW, <1500 g) infants in Neonatal Intensive Care Units (NICUs). Neonatal sepsis is divided into early-onset (if symptoms start before 72 h of life) and late-onset (if symptoms start afterward). The incidence of early-onset neonatal sepsis in developed countries is 0.9–1.5 per 1000 live births. One of the major difficulties in the management of neonatal sepsis is getting an accurate diagnosis. Unlike older patients, newborns have very subtle presentations, and multiple conditions resemble neonatal sepsis. Auxiliary tests have limited value and are difficult to interpret due to low sensitivity and changing normal ranges during the neonatal period. As a result, a combination of findings is necessary to provide a correct diagnosis of neonatal sepsis. The World Health Organization identified seven clinical signs: difficulty feeding, convulsions, movement only when stimulated, and respiratoryrate >60 per min, severe chest indrawing and axillary temperature >37.5 °C or <35.5 °C that should prompt neonatal referral to a hospital. Early diagnosis of neonatal sepsis continues to pose a problem to the doctors caring for newborns. It is proposed that coagulation dysfunction;one of the many complications of neonatal sepsis is present in around 10% of sick newborn. Sepsis is the systemic inflammatory response to infection. Between the most important features of sepsis, contributing significantly to its outcome is activation of coagulation with concomitant down regulation of anticoagulant systems and fibrinolysis. Inflammation-induced coagulation on its turn contributes to inflammation, and dysregulation of host-derived mediators of inflammation is resulting in severe sepsis that characterizes multisystem organ dysfunction.D-dimer is a fibrin degradation product or FDP, a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis, increased in disseminated intravascular coagulation.This study aimed to evaluate the role of serum D-dimer as a marker of neonatal sepsis.After approval of the Local Institutional Ethical Committee of Menoufia University Hospital and after taking a written consent from the parents of the participants. This study was carried out on100 neonates admitted at the neonatal intensive care unit of Menoufia university hospitals and Shebin Elkoum teaching hospitalin a period fromSeptember 2018 to August 2019.They were classified into threegroups: 1-group I: Including 35 Patients (20 males and 15 females) with confirmed neonatal sepsis with blood culture. 2-group II: Including 15 Patients (5 males and 10 females) with suspected neonatal sepsis clinically with negative blood culture. 3-group III (Control):Including 50 healthy neonates (27 males and 23 females) age and sex matched. The inclusion criteria were: Septic neonates according to clinical and lab investigations,full term & preterm bothsexes male and female,Early onset neonatal sepsis (less than 72 hours of age) andLate onset neonatal sepsis (more than 72 hours of age). The exclusion criteria were: Congenital anomalies, Birth asphyxia and surgical problems, IDM, DIC and pathological jaundice.All patients were subjected to: detailed history, anthropometric measurement, clinical examination, laboratory investigations
Summary & Conclusion65including: Complete Blood Count (CBC), C Reactive Protein (CRP), liver function tests, kidney function tests, blood culture and serum D-dimer level. Our results showingthat there was statistically highly significant difference as regards maternal history but there was statistically non-significant difference asregards gestational age, sexand mode of delivery.There was statistically highly significant difference between studied groups as regards weight, HC, AC and CC. weight (kg) was significantly lower in group 1 &2 than group 3. As regard length (cm) of neonates the difference among the 3 groups was non-significant.There was statistically highly significant difference as regards RR;group Iwas higher inmean RR than the other groups.HR,group Iwas higher in mean HR than the other groups.group II was higher in mean Temp than the other groups.group 1 was higher in lethargy, seizures, irritability, hypotonia and pulge anterior fontanelle, grunting and chest retraction, poor perfusion, hypotension, refusal of feeding, hepatosplenomegaly and distension. Statistically significant difference as regards apnea, shock, vomiting than other groups.There was statistically a highly significant difference between the three groups as regards mean of CRP, TLC, total neutrophil count, total HSS,Mean Creatinine and mean clinical sepsis scorebut there was statistically significant difference as regards to HB and AST, statistically non-significant difference as regards to platelet count, mean urea and ALT.There was statically non-significant difference between full-term and pre-term neonates in D-dimer measurement (at onset of diagnosis ofsepsis) and (at3rdday of diagnosisof sepsis).There was statistically +ve correlation between D-dimer measurement (at onsetof diagnosis of sepsis) and (at 3rddayof diagnosis of sepsis) with CRP, TLC, HSS, SS in studied neonates, with +ve strong correlation between D-dimer, CRP, HSS andSS, +ve fair correlation between D-dimer and TLC.There was statistically non-significant difference in survived and died neonates in proved & suspected sepsis groups as regards to sex, maternal history, MOD, D-dimer, TLC, CRP, TSB, DSB, SS and HSS.The ROC curve was done to determine the cut off level of sepsis markers.Thecut off level for TLC was set at (>11.1×100/mm3) cells, that of I: T ratio was set at > 0.50 and for CRP was > 11.5mg/L, D-dimer at 0 days of diagnosis of sepsis was > 1195 ng/ml and D-dimer at 3 days of diagnosis of sepsis was > 2210ng/ml.By using the receiver-operating characteristic curve, comparison of the D-dimer data to the tested other markers of sepsis including CRP, TLC, HSS and I: T ratio showed that the D-dimer and CRP were the most sensitive marker (97.1%) compared to the sensitivity of TLC (82.9%), I: T ratio (57.1%).As regarding the specificity of the markers, the D-dimer at onsetof diagnosis of sepsis was with specificity (78.5%), D-dimer at 3rddayof diagnosis of sepsis was (76.9%), than CRP (90.8%), I:T ratio (58.5%), TLC and HSS (55.4%).