ABSTRACT
This study was conducted to estimate the sensitivity and specificity of some early diagnostic predictors of neonatal sepsis including: inflammatory cytokines [interleukin-6 [IL-6], tumor necrosis factor alpha [TNF-alpha]], enzymatic antioxidants [glutathione peroxidase [GPX], superoxide dismutase [SOD]], non enzymatic antioxidants [uric acid [UA], albumin [ALB]] and markers of oxidative stress [nitric oxide [NO], creatine phosphokinase [CPK], malondialdehide [MAD]] as well as to evaluate the role of oral administration of vitamin A and / or vitamin C as adjuvant line of therapy. This study was done on 60 septic full term neonates who were admitted to Neonatal Intensive Care Unit [NICU], Tanta University Hospital. Another 15 healthy neonates with matched age and sex served as a control group. The septic neonates were classified randomly into 4 equal groups according to the type of therapy; Group I received antibiotics as a sole line of therapy, Group II received antibiotics and oral vitamin A [5000 IU every other day], Group III received antibiotics and oral vitamin C [100 mg / kg], and Group IV received antibiotics and both oral vitamins A and C. All neonates were subjected to thorough clinical examination, sepsis work up as well as estimation of: IL-6, TNF-alpha, GPX, SOD, UA, ALB, NO, CPK and MDA. Follow up for 2 weeks was done when a second blood sample was taken for the same laboratory investigations. Bacterial cultures revealed that the most common pathogen was Klebsiella [37%] and the most sensitive antibiotic was Imipenem [++++], The sensitivity and specificity of IL-6 and SOD were 100% followed by NO and CPK [100% sensitivity and 93.33% specificity]. Before therapy, there were significant increases in IL-6, TNF-alpha, GPX, SOD, NO, CPK, MDA and significant decreases in ALB and UA in septic neonates as compared with the control group. After therapy, significant decreases in inflammatory cytokines, enzymatic antioxidants and markers of oxidative stress were found in all the septic groups but evidently more in group IV, followed by group II
Conclusion: IL-6 and SOD are advised as the best predictors for early diagnosis of neonatal sepsis followed by NO and CPK. Oral administration of vitamin C adds mostly no benefit more than the sole administration of antibiotics. On the other hand, the combined administration of both vitamins A and C acts in synergism better than the sole administration of vitamin A and can be recommended as an additional line of therapy in neonatal sepsis that can decrease the membrane lipid per oxidation and the risk of free radical damage