Evaluation of the role of presepsin [soluble cd 14 subtype] in the diagnosis of neonatal sepsis in preterm newborns

Objective: The present study was conducted to evaluate the role of presepsin as an early and rapid predictor of bacterial infection in newborn infants

Methods: This study was carried out on 50 preterm newborn infants with clinically suspected early onset sepsis admitted to the neonatal intensive care unit at Alexandria University Maternity Hospital, All studied newborns were subjected to History taking, detailed physical examination and sepsis work -up, including complete blood count, blood culture, CRP, CSF analysis if indicated and quantitative measurement of preseason

Results: The mean birth weight of the studied newborn infants was 1520 g and the mean gestational age was 32.7 weeks with no statistically significant difference as regard the preseason results. Virginities was the main maternal risk factor for EOS, present in 80 % of the studied newborn infants. The majority of cases of positive culture for Klebsiella were negative for preseason, and this was statistically significant, Presence of toxic granules had the highest incidence among laboratory markers in the CBC in the studied group, Preseason was positive in 48% of newborns and the mean value of preseason was 1397.6 ng/L, Most cases with positive initial CRP readings were positive for preseason and this was statistically significant. There was no significant difference in preseason results as regard clinical score, total laboratory score and both laboratory and clinical scores. All cases that had meningitis were positive for preseason, and most cases that didn't have meningitis were negative for preseason and this was statistically significant. There was no statistically significant difference between preseason results and duration till admission, Apgar score or hospital stay

Conclusion: We concluded that preseason is a useful, quickly and easily performed marker for diagnosis of neonatal, sepsis. Its results are comparable to the CRP and seemed to be superior to conventional CBC tests. Furthermore, presepsin is a promising prognostic marker that could identify high risk newborns to severe sepsis, but it may not be elevated in response to infections caused by organisms like Klebsiella

Rates of Neonatal Morbidity and Mortality in the Neonatal Intensive Care Unit at Alexandria University Children's Hospital: one year study

Objectives: To determine the rates of neonatal morbidity and mortality in neonatal intensive care unit of Alexandria University Children's Hospital

Study Design: Hospital records of neonatal admissions at neonatal intensive care unit [NICU] of Alexandria University Children's Hospital [AUCH] from 1st January 2012-31[st] December 2012 were analyzed retrospectively. Percent neonatal mortality and morbidity were calculated from the record, along with the causes of neonatal morbidity. The data were collected and statistically analyzed

Results: Out of 2063 neonates, 1098 [53.2%] were males while 965 [46.8%] were females with a male to female ratio of 1.3: 1. Majority, 1633 out of 2063 [79.2%], of the neonates was admitted during the 1st day of their life, mean age 2 days. Of total neonates included in the study 635 neonates [30.8%] died during their hospital stay. Significant risk factors [P<0.05] associated with neonatal mortality were: Caesarean delivery, multiple births, maternal infection, neonatal respiratory distress, prematurity, and low birth weight [LBW]. The mortality rate decreased with the increase in birth weight, as well as gestational age. Prematurity, neonatal jaundice, Respiratory distress and sepsis were the most common causes of neonatal morbidities contributing 70.4%, 70%, 65.4% and 48.2% respectively. Overall mortality was 30.8%.Th e three most common causes of neonatal mortalities were Respiratory distress [29.2%], Prematurity [27.8%] and neonatal sepsis [23.1%]

Conclusion: Majority of patients were admitted in the first day of life which indicates that improvement in the prenatal, natal and nursery care as a whole can reduce the neonatal mortality and morbidity in preterm as well as full term neonates

Comparative study of visual assessment of neonatal jaundice and laboratory estimation of total serum bilirubin in full-term newborn infants

Neonatal hyperbilirubinemia is the most common condition that requires medical attention in newborns. The assessment of jaundice can be carried out using several methods. The aim of this work is to compare visual assessment and laboratory estimation of TSB in full term newborn infants and to evaluate the accuracy of visual assessment of neonatal jaundice in guiding management decisions in the out-patient settings. The study was conducted in the out-patient clinic of Alexandria University Children's Hospital for a period of eight months. 57.2% of babies were male infants while 42.8% were females with a mean gestational age of 38.5 +/- 1.58 weeks and mean weight of 2.98 +/- 0.62 kg. The total agreement between the lab-based management decision and the clinically based decision was 84.2% out of 500 cases involved in the study. Sensitivity of visual assessment was 95.8% while specificity was 80.5%. The false positive rate was 39.2% and positive predictive value was 60.8%. False negative rate and negative predictive value were 1.6% and 94.8% respectively. Also, the Spearman correlation of dermal zones determined by visual assessment and lab TSB in the whole sample was 0.76 [p = 0.000]. It was highest in Infants < 3 days [0.94] and lowest in infants > 14 days [0.69]. In conclusion, visual assessment of neonatal hyperbilirubinemia is a useful clinical tool, if used correctly and by trained medical personnel in resource-poor countries, where there is little or no access to reliable laboratory-based diagnostic services

Immune modulation in polytrans fused Egyptian children with thalassemia

Fifteen children with beta thalassemia major, with no evidence of infection, were evaluated for their interleukin-2 [IL-2] production, complement [C[3]] level, as well as immune complex formation. Eight healthy children served as control subject. The study revealed a significant decrease in IL-2 production and a significant increase in immune complexes formation in thalassemic children. Regarding C[3] level, it shows marked decrease in children with thalassemia when compared to normal one. from the immunological point of view, the present work shows some interesting findings, that poly transfused beta-thalassemic children are presented by certain functional immune deficiency determined by a defect in T cell response, as denoted by reduction in IL-2 level. Decrease in C[3] level is also observed which is the result of the increase in immune complex formation obtained in children with thalassemia