الفهرس 
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Abstract
SUMMARY
V
itamin A is an essential micronutrient that is needed in sufficient amounts in our diet to keep a proper physiological well-being. Vitamin A deficiency (VAD) is a main community health quandary in low- and middle-income countries, and at least 250 million children all over the world experience VAD as stated by the WHO.
Sepsis is a clinical syndrome resulting from a dysregulated systemic inflammatory response to infection. It is characterized by a generalized pro-inflammatory cascade, which may lead to widespread tissue injury. Sepsis is a leading cause of morbidity and mortality in children worldwide.
Aim of study: In the current study we aimed to assess the prevalence of vitamin A deficiency in critically ill children with sepsis and to assess the association between vitamin A deficiency and the clinical outcomes, for early diagnosis and prediction of sepsis severity.
Methodology:
This cross_ sectional study was held in pediatric intensive care units (PICUs), Ain Shams University Children’s Hospitals.
Inclusion criteria:
• Patient group: 40 patients admitted to PICU with sepsis.
Age: from 1 month to preschool age.
• Control group: 40 children age and sex matched healthy children.
Exclusion criteria:
• Age ˃ 5 years
• Conditions of underlying organ dysfunction
• Had received chemotherapy or radiotherapy
• Hematological malignancies
• Primary or acquired immunodeficiency
• Discharged against medical advice with an uncertain prognosis.
Methods:
• Full history and examination were done for each patient.
• Anthropometric parameters were measured and plotted on WHO Z score (WHO 2006).
• Prism score was calculated.
• Dietary assessment:
o Quantitative food frequency questioner for estimation of vitamin A intake.
o Routine laboratory investigations.
o Assessment of serum levels of vitamin A through a 2ml blood sample which was withdrawn once within 24 hours after diagnosis of sepsis before starting enteral or parenteral nutrition.
Results:
• The study enrolled 40 children with sepsis and 40 matched healthy children so there was no statistically significant difference between controls and patients group among age and sex, with median age 4 (2 – 12) months for both groups with male predominance (60.0%).
• Regarding body measurements in this study there were significantly lower values among sepsis group than control group for z scores of weight, height/length, BMI and MAC of the studied subjects, that indicates increase malnutrition prevalence among patients group than controls group.
In the present study, by comparing VAD between patients and controls, we found that all patients in sepsis group (100%) had VAD in comparison to only (30%) among controls. We also found that in sepsis group patients who had septic shock, NPO, on ventilators and those who died; had lower levels of vitamin A than other patients, illustrated that VAD may be had a role in sepsis related morbidity and mortality.
There was a positive correlation between vitamin A and BMI Z score and MAC (the higher vitamin A level, the better BMI Z score and MAC values). While there was a negative correlation with prism 3 and prism 4 (the lower vitamin A level, the higher prism 3 and prism 4 scores).
• ROC curve for assessment of vitamin A as a predictor of sepsis was done and we found that at cut off value ≤9 μg/dl, the Sensitivity, Specificity, PPV and NPV were 100% for each