Role of Procalcitonin in the diagnosis of Neonatal Sepsis

Objectives: Early diagnosis of neonatal sepsis and appropriate treatment decreases the mortality and morbidity of these infants. The aim of this study was to assess the role of procalcitonin [PCT] as a marker in the early diagnosis of neonatal sepsis

Study design: 35 neonates with early onset sepsis [admitted to the Neonatal Intensive Care Units at El-Minia Children University Hospital [from August 2012 to August 2013] were included in the study. Another 35 healthy neonates with no clinical and biological data of infection were taken as control, they were subjected to thorough history taking, routine laboratory investigations and serum Procalcitonin and C-reactive protein [CRP] were determined by ELISA

Results: Mean levels of procalcitonin and CRP in neonates with sepsis were significantly higher than the control. There was a significant moderate positive correlation between procalcitonin and C-reactive protein and insignificant correlation between procalcitonin and total leukocytic count among the neonates with sepsis. Also procalcitonin had high sensitivity, specificity, high positive predictive value and high negative predictive value. PCT showed higher sensitivity in comparison to that of CRP

Conclusion: Procalcitonin is a sensitive, independent and useful biomarker than CRP in early diagnosis of neonatal sepsis

Serum level of ghrelin in umbilical cord in small and appropriate for gestational age newborn infants and its relationship to anthropometric measures

Ghrelin natural growth hormone secratogogue originating from the stomach, is characterized by non endocrine activities such as orexigenic effects and modulation of the endocrine and metabolic response to variation in energy balance. However it nor not known whether it plays a role in energy homeostasis during fetal life or not. The study aims to determine cord blood ghrelin level in small for gestational age [SGA] infants compared with appropriate for gestational age [AGA] infants and its relationship to anthropometric measurements at delivery. Fifty newborn infants, 30 SGA, their gestational age ranged from 36 to 39 weeks and their weight ranged from 1 to 2.2 Kg and 20 AGA infants, their gestational age ranged from 38 to 41 weeks and their weight ranged from 3 to 3.6 Kg were included in the study and were subjected to complete clinical examination, anthropometric measurements and ghrelin assay. The study showed that the cord blood ghrelin level in SGA infants [mean :t SD.; 8.18 :t 1.00 pg/ml] was Significantly greater than that in AGA infants [4.37 :t 0.50 pg/ml]. [p-value 0.0001]. Cord ghrelin level was correlated negatively with gestational age, weight, length and body mass index in SGA group[r=-0.55;p =0.002, r=-0.63,p =0.0001,r=-0.61, p=0.07 and r=0.56, p=0.001] and in AGA group [r=-0.48 ;p =0.05, r=-0.59,p =0.6, r=-0.37, p=0.7 and r=--0.47, p=0.7]. The study showed that the most important factor affecting ghrelin level in both SGA and AGA neonates was their weight, while the least factor is their mid arm circumference. Cord ghrelin concentration increased in small for gestational age infants due to state of prolonged under nutrition. The source of ghrelin remain unknown, it may be either from the placenta or fetal tissues origin

Platelet associated CD154 in immune thrombocytopenic purpura in children

CD40-ligand [CD 154] is expressed on activated CD4+T lymphocytes and is essential for the T cell-dependent activation of B lymphocytes. CD154 is also expressed at the activated platelet surface. The study aim to investigate the role of CD154 in ITP pediatric patients and correlate their levels with the course and progression of the disease. This study included 25 patients with acute ITP [13 females and 12 males] with age ranged between 2-6 years [group 1] and 25 patients with chronic ITP [14 females and II males] with an age ranging between 8-12 years [group II], also 25 apparently healthy children [10 females and 15 males] with an age ranging between 3-12 years as control [group III]. Studied groups were subjected to the following investigations; complete blood count, bone marrow examination and flowcytometric analysis of CD154 B lymphocyte counts. We found that there was a highly significant increase in CD 154 in patients with acute ITP compared with chronic ITP and control group [p=0.001 and 0.9001 respectively]. Also there was a negative correlation between CDI54 and platelet count in acute and chronic groups [r=-0.6, p=0.004 and r=-0.5, p=0.005 respectively]. There was a positive correlation between CD 154 and lymphocytic count in acute and chronic groups [r=0.422, p=0.007 and r=0.77, p=0.001 respectively]. In conclusion, the increased number of CD 154 might be one of the mechanisms that cause immune regulation dysfunction in ITP. Furthermore, the count is related to the severity of the disease as it was highly increased in acute phase than chronic and therefore CD154 expression is increased in ITP and is able to drive the activation of auto reactive B lymphocytes in this disease