Prognostic value of plasma pro-adrenomedullin and antithrombin levels in neonatal sepsis

Neonatal sepsis is one of the major causes of morbidity and mortality in neonates. Proper diagnosis and management of neonatal septicemia can markedly affect prognosis of neonatal sepsis. In sepsis serum pro-Adrenomedullin level [pro-ADM] was known to be increased while Anti thrombin is rapidly depleted as a result of decreased synthesis, increased destruction, and enhanced clearance. The aim of this study was to clarify the prognostic value of serum Pro-ADM and Anti thrombin level in neonatal sepsis. 40 full term neonates with sepsis were enrolled in this study including 20 cases with mild sepsis and 20 cases with severe sepsis. They were admitted to the neonatal intensive care unit, they included 26 males and 14 females with a mean birth weight of 3.2 +/- 0.26 kg. Twenty healthy full term neonates of matched age and sex served as a control group. Serum levels of Pro ADM and Antithrombin were measured in all patients and control group. Serum Pro ADM level was significantly higher in neonates with sepsis than control group, was significantly higher in severe than mild sepsis and was significantly higher in the unsurvived cases. Antithrombin concentrations were significantly lower in neonates with sepsis than control group, significantly lower in severe than mild sepsis and significantly lower in neonates with sepsis who died than who survived. In conclusion, higher pro-ADM and lower initial AT levels in neonatal sepsis are associated with severe disease and increased risk of mortality

Risk factors for isolated periventricular leukomalacia in very low birth weight infants: a case-control study

Periventricular leukomalacia [PVL] is a major cause of neurological disabilities in preterm newborn infants. PVL can occur as isolated [iPVL] or associated with massive intraventricular-preivenfricular hemorrhage [grade 3 and grade 4 IVH]. This study aimed to determine the antenatal and neonatal risk factors associated with iPVL. We retrospectively studied the medical record of very low birth weight infants [birth weight of less than 1500 gm], delivered at King Abdulaziz Medical City-Riyadh [KAMC-CR] and admitted to the neonatal intensive care of KAMC-CR between Jan 2004 and Dec 2008. A total of 696 VLBW infants were born alive in the study period, 20 infants developed iPVL, with prevalence of 2.87%. Neonates that have grade 3 IVH, grade 4 IVH, or major congenital malformation were excluded. The 20 affected infant with iPVL [iPVL group] were compared with 98 VLBW infants without 1PVL [No iPVL group] from the same cohort. At multivariate logistic regression model, larger birth weight odd ratio [OR]: 0.22; 95% confidence interval [CI]:0.059-0.82; P value: 0.024, early neonatal hypotension that needs therapy by a second inotropes like dobutamine [OR: 6;95%, CI:1.23-29. 17; P value:0.031]. The delay in surgical closure of hemodynamic significant PDA [hsPDA] [OR :0.8, 95% Cl :0.7-0.9, P value:0.002], occurrence of neonatal sepsis [OR:1.38; 95%CI:1.03-1.84; p value:0.031], retinopathy of prematurity [ROP] [OR:2. 77, 95% CI:1.12-6.83; P value:0.026] were associated with an increased risk of iPVL. In conclusion, early hypotension, neonatal sepsis, hsPDA and the delay of its surgical closure are strong risk factors for iPVL