Predictive Ability of Conventional and Combined Apgar Scores versus Neonatal Resuscitation and Adaptation Score in Early Neonatal Assessment.

OBJECTIVE: The aim of this study was to assess the Neonatal Resuscitation and Adaptation Score (NRAS) value compared with the conventional and combined Apgar scores in predicting neonatal morbidity and mortality. STUDY DESIGN: A prospective cohort study was conducted on 289 neonates delivered at the Menoufia University Hospital. Trained physicians measured conventional Apgar score, combined Apgar score, and NRAS for the neonates at 1 and 5 minutes after delivery in the delivery room. Admitted neonates were followed during their stay to detect any adverse outcomes. RESULTS: Morbidities such as the need for neonatal intensive care unit admission, mechanical ventilation, surfactant and inotropes administration, need for extensive phototherapy, intravenous immunoglobulin or exchange transfusion, anemia, metabolic acidosis, abnormal liver and kidney function tests, coagulopathies, hypoglycemia, development of seizures in the first 72 hours of life, and positive changes in cranial ultrasound were significantly higher in neonates who lie within low or moderate NRAS than conventional and combined Apgar scores (p < 0.05). As predictors of mortality, the low and moderate values of the NRAS had higher positive predictive values at 1 (73.91 and 30.61%) and 5 minutes (88.89 and 50.94%) than the conventional Apgar scores at 1 (49.18 and 20.53%), 5 minutes (81.25 and 41.27%) and the combined Apgar scores at 1 (35.63 and 12.45%) and 5 minutes (53.1 and 41.33%). CONCLUSION: Our study suggests that the NRAS is better than conventional and combined Apgar scores in predicting neonatal morbidity and mortality. Furthermore, a depressed 5-minute NRAS is more predictive of mortality than 1-minute score. KEY POINTS: · NRAS is better than conventional and combined Apgar scores in predicting neonatal morbidity.. · NRAS is more predictive of mortality than conventional and combined Apgar scores.. · A depressed 5-minute NRAS is more predictive of mortality than 1-minute score..

ABCB1 polymorphisms and steroid treatment in children with idiopathic nephrotic syndrome.

BACKGROUND: The most common cause of nephrotic syndrome (NS) is idiopathic nephrotic syndrome (INS), also called nephrosis. Although most patients respond to steroid therapy, there is unequal response to treatment suggesting the involvement of genetic factors. The current study was conducted to evaluate the influence of two single nucleotide polymorphisms (SNPs) in ABCB1 (C3435T and C1236T) on the steroid treatment response in INS children. MATERIALS AND METHODS: Genotyping of ABCB1 C3435T and C1236T polymorphisms by real time PCR were conducted on 120 INS children, 80 steroid sensitive (SS) and 40 steroid resistant (SR). RESULTS: A significant difference in the distribution of ABCB1 C3435T and C1236T genotypes was observed between SS and SR patients. C1236T polymorphism was associated with steroid resistance in INS children (odds ratio: 2.27, 95 % confidence interval: 1.2-4.4; P = 0.012). The frequency of the T allele was significantly higher in SR than in SS patients (81.2 vs. 65.6%, respectively). The odds ratio for the C3435T polymorphism in response to steroid treatment was smaller than that of the polymorphism C1236T, and did not reach statistical significance (odds ratio: 1.1, 95 % confidence interval: 0.6-1.9; P = 0.77). CONCLUSION: Our results suggested that C1236T polymorphism in ABCB1 gene was associated with steroid resistance. A higher proportion of SR children had C1236T TT genotype and T allele, these patients may require other therapeutic strategies.

The potential role of incorporating real-time PCR and DNA sequencing for amplification and detection of 16S rRNA gene signatures in neonatal sepsis.

OBJECTIVES: This study aimed to explore whether 16S rRNA gene amplification by real time PCR and sequencing could serve as genetic-based methods in rapid and accurate diagnosis of neonatal sepsis. PATIENTS AND METHODS: This case control study was conducted on 40 neonates suffering from sepsis like manifestations recruited from the neonatal intensive care unit of Menoufia university hospital over a period of 6 months. Their blood samples were used for paired analysis of bacterial growth using BACTEC 9050 instrument and real time PCR assay with subsequent DNA sequencing for bacterial species identification. RESULTS: The detection rate of culture proven sepsis was 70%. By using real time 16S r RNA PCR amplification method, the detection of bacteria was improved to 80%. Real time PCR revealed sensitivity, specificity, positive predictive value and negative predictive value of [100%, 66.7%, 87.5% and 100%] respectively. Compared to culture, the 16S rRNA real time PCR demonstrated a high negative value for ruling out neonatal sepsis. There was significant statistical difference between the PCR positive and negative cases as regards the hematological sepsis score. The results demonstrated the ability of DNA sequencing to recognize 4 pathogens which were negative by blood culture. The time consumed to detect sepsis using blood culture was up to 5 days while it took up to 16 h only by PCR and sequencing methods. CONCLUSION: 16S rRNA gene amplification by real time PCR and sequence analysis could be served as ideal and reliable genetic-based methods to diagnose and rule out sepsis with provision of additional data that cannot be obtained by routine laboratory tests with a shorter turnaround time than those with culture-based protocols.