ABSTRACT
Background: Neonatal sepsis is the single most important cause of neonatal deaths in the community. It remains a major cause of mortality in newborn and life- threatening disorder in infants
Aim: To assess the validity of using diagnostic markers in predicting neonatal sepsis
Methodology: This was a systematic review and meta- analysis. More than 200 potentially relevant studies were collected in 2 years standing from 2012 to 2014 but only 42 of them met the inclusion criteria. A standard method for meta- analysis of diagnostic markers evaluation was performed using Biostat, Comprehensive Meta- analysis version 3.0.
Results: Meta- analysis was performed on 2722 neonates divided into 2 groups according to their clinical manifestations of neonatal sepsis and laboratory findings. PROM was the commonest risk factor predisposing to sepsis. Klebsiella and staphylococcus aureus were the most common isolated organism. Based on the results from included studies in this review, 6 predominant markers were used to evaluate early diagnosis of neonatal sepsis, PCT, IL- 6, TNF- alpha, CD64, slCAM and Eselectm. Procalcitonin was highly significantly elevated with sensitivity [0.93] whereas specificity was [0.87] and it had the most diagnostic accuracy [0.95]. SICAM was the most sensitive marker [0.95] its diagnostic accuracy and specificity were [0.93] and [0.90], TNF- alpha had diagnostic accuracy [0.92] sensitivity and specificity were [0.86], the sensitivity of Eselectin was [0.92], its diagnostic accuracy and specificity were [0.91] and [0.82]. IL6 had diagnostic accuracy [0.93]; the specificity and sensitivity were [0.90] and [0.88]. CD64 was the most specific biomarker for predicting neonatal sepsis [0.91]. sensitivity [0.87] accuracy [0.92]
Conclusion: Based on results from the studies included in this review, it was dear that serum slCAM had a high sensitivity for diagnosis of neonatal sepsis; CD64 had a high specificity and serum procalcitonin had the most diagnostic accuracy
ABSTRACT
Objective: To evaluate inflammatory markers in full term neonates with unconjugated hyper-bilinibinemia. Design: Prospective case control study. This study was done in the department of pediatrics screening clinic, Al-Galaa Teaching Hospital, in Cairo, Egypt from October 2012 to June 2014
Subjects and Methods: The study was done on seventy five full term neonates their age ranged from 3 to 6 days after birth, fifty with unconjugated hyperbilirubinemia compaired to twintyfive normal neonates as control group with matched age and sex. All neonates were subjected to history taking [including gestational age, postnatal age] and clinical examination, anthropometric data, and laboratory investigations including complete blood count, CRP and inflammatory markers TNF-a and ILIp concentration by ELISA
Results: Regarding total bilirubin level in unconjugated hyperbilirubinemia neonates, there was statistically significant to inflammatory markers TNF-a and IL-Ip[p-value was <0.001]. The same finding were also it was found that both inflammatory markers IL-lp and TNF-a showed statistically significant positive correlation with breast feeding p-value was 0.021 for IL-lp and 0.003 for TNF-a respectively. Inflammatory markers IL-lp and TNF-a increasing levels showed positive correlation with neurological examination [Lethargy or irritability, p-value were 0.01 1 for IL-p and 0.046 for TNF-a respectively
Conclusion: Inflammatory markers IL-lp and TNF-a levels increased in neonatal unconjugated hyperbilirubinemia. Inflammatory markers IL-lp and TNF-a was found correlation between neurological examination. Recommendations: Further studies on larger sample size [are advised to verify the diagnostic and prognostic value of inflammatory markers in neonatal unconjugated hyperbilirubinemia which may help also in treatment. Key words: Inflammatory markers, IL-lp and TNF-a, neonatal unconjugated hyperbilirubinemia, Bilirubin and neurological dysfunction