الفهرس 
Overview of Early Onset Neonatal SepsisOnly 14 pages are availabe for public view
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Abstract
N
eonatal sepsis defines the systemic condition that arises from bacterial, viral, or fungal origin, associated with hemodynamic changes and clinical findings and causing severe morbidity and mortality.
EOS typically represents an infection that presents itself within the first 3 days of life (<72 h), but some researchers extend this limit up to the first week of life. LOS is described as an infection occurring after the fourth or seventh day of life within the neonatal period. EOS is considered as a maternal-fetal infection and LOS is mainly considered hospital-acquired.
Early diagnosis is important for early intervention and treatment. This diagnosis in neonates is usually based on frequently repeated laboratory tests (white blood cell count with the immature-to-total ratio, C-reactive protein, and procalcitonin levels) with accompanying clinical manifestation and sepsis scores (Rodwell’s hematological scores & Tollner’s scores & SNAP 11)
The most valuable method for diagnosis is blood culture; however, false positivity due to contamination or false negativity despite ongoing fatal bacterial infections can be seen.
However, there is still a need for a novel biomarker that could be used as a specific predictor in the early diagnosis of newborns’ infection. A new acute-phase protein called pentraxin 3 (PTX3) has the potential to fulfill those requirements. Pentraxin 3 belongs to the family of long pentraxins, which is synthesized in numerous cells of the body, under the influence of proinflammatory factors in the presence of lipopolysaccharide or fragments of pathogens. Its concentration increases rapidly in various infections and plays an important in the early phase of inflammation.
The study is aimed to evaluate the diagnostic value of cord Pentraxin 3 in early onset neonatal sepsis.
This study is a prospective cohort study, was carried out on 80 neonates with risk factors for early-onset sepsis admitted at Ain Shams University NICUs. In addition to full history taking, thorough clinical examination and clinical sepsis scores, cord blood sample was withdrawn to measure PTX3 serum levels to compare it with one of routine sepsis workup; C-reactive protein (CRP). Neonates were followed up for 72 hours where they were divided into sepsis group (n:34) and control group (n:46).
The main results of the study revealed that:
Mean GA was 36.76±3.01 weeks (range;30-42 weeks),birth weight 2.87±0.82 kg, female distribution was 58.8% and male 41.3%, 42.5% of the studied group were preterm.
73.8% had PROM, 26.2% had chorioamnionitis, and 66.3% were delivered by CS and 33.8% were NVD.
Cardiac support (inotropes were used in 18.8% of studied neonates), respiratory support (non-invasive ventilation was used in 33.7% and invasive ventilation in 10%).
42.5% of total studied neonates had positive CRP, 52.5% had positive Tollner score, 43.8% had positive Rodwell score and 42.5% had positive SNAP II score.
42.5% of the studied group were diagnosed as early onset sepsis.
GA was significantly decreased among the sepsis group. Tollner score, Rodwell score, and SNAP II score were significantly increased among sepsis group. WBCS, CRP and PTX3 were significantly increased in sepsis group compared to control both baseline and on follow up. Hb level was significantly decreased in sepsis group. Male gender, CS, use of inotropes and non invasive ventilation were more frequent among sepsis group.
The highest validity for early diagnosis of EOS was PIX3 (sensitivity 91.2%, specificity 82.6% for a cutoff value>140ng/ml), Tollner score (sensitivity 88.2%, specificity 73.9%), Rodwell score (sensitivity 79.4%, specificity 82.6), SNAP II score (sensitivity 76.5%, specificity 82.6%) and finally CRP with lowest sensitivity (sensitivity 64.7%, Specificity 73.9%).
PTX3, Rodwell score, and SNAP II score were significant independent predictors for sepsis.
Gender and mode of delivery showed no effect on PTX3 concentrations in studied groups.
Significant positive correlation between PTX3 and Rodwell score, SNAP II score, Tollner score, CRP and WBCs and negative correlation between PTX3and gestational age.
Conclusion
C
ord PTX 3 could be used as a new biomarker for prediction of early onset neonatal sepsis in neonates with high risk of infection with high sensitivity and specificity (sensitivity 91.2%, specificity 82.6% for a cutoff value>140ng/ml). It is negatively correlated to gestational age. Neither gender nor mode of delivery showed effect on PTX3 concentrations.
Recommendations
Further studies on a large geographical scale and a larger sample size emphasize our conclusion.
Further studied are needed to evaluate the diagnostic value of Pentraxin 3 in late onset neonatal sepsis.
Testing modalities for the detection and diagnosis of EOS must continue to be developed, with novel laboratory methods still being tested.