ABSTRACT
The objectives is to evaluate the role of thrombopoietin [Tpo] and esythropoietin [Epo], as reliable indicators of neonatal sepsis and the value of rhuEpo in improving the outcome of septic neonates. A prospective study was conducted on 120 sick neonates with sepsis. Sixty two [51.7%] were fullterms and 58 [48.3%] were preterms with a mean gestational age of 32.8. +/- 2.9 weeks. The mean birth weight was 2.7 +/- 0.98 Kg and the mean age of sampling was 5.5 +/- 1.9 days. Sixty neonates received treatment with rhuEpo in addition to the classic therapy of sepsis for 10-14 days. Another group of 60 septic neonates received the classic therapy of sepsis only for 10-14 days. Thirty healthy neonates, age and sex matched with the study groups, were served as a control group. Serum Tpo and Epo levels were measured by ELISA [enzyme-linked immunosorbent assay]. Significant higher differences of serum Tpo and Epo levels were found between septicemic neonates and control group [P<0.001]. The higher the septic score, the higher the serum levels. Septicemic neonates with DIC had significantly higher serum Tpo levels than septicemic neonates without DIC [216.42 +/- 66.5 pg/ml, 172.69 +/- 62.4 pg/ml P=0.042]. Also, septicemic neonates with pallor had significantly higher serum Epo levels than those without pallor [24.1 +/- 7.4 IU/ml, 20.3 +/- 5.2 IU/ml, P=0.022]. On admission, the serum Tpo levels ranged between 39-344 pg/ml with a mean +/- SD of 173.76 +/- 62.67 pg/ml and was statistically significant when compared with control group [32-114 pg/ml, 69.63 +/- 21.4 pg/ml, P=0.001]. After improvement, the serum Tpo levels ranged between 29-133 pg/ml with a mean of 74.5 +/- 25.3 pg/ml and insignificant difference when compared with control group [P=0.37]. Serum Epo levels at the onset [21.14 +/- 6.28 IU/ml] and after improvement [8.81 +/- 3.71 IU/ml] were significantly higher [0.001 and 0.009 respectively] when compared to controls [6.73 +/- 2.9 IU/ml]. Septicemic neonates who received treatment with rhuEpo in addition to the classic therapy showed significantly lower mortality rate [18 patients died, 30%] than those who received the classic therapy only [34 patients died. 56.7%], P=0.003. Serum Tpo and Epo levels are increased in neonates with sepsis, the higher the septic score, the higher the serum levels of both markers. Increase in serum Epo levels during neonatal septicemia is a multifactorial process rather than affecting the haemostatic mechanisms only. The use of rhuEpo in management of septicemic cases could improve the outcome of septicemic patients and decrease the mortality rate