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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 155 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 |