| Abstract: |
SummaryNeonatal sepsis is a major clinical problem in neonates with high morbidity and mortality. It represents a challenge for diagnosis and management.Since the outcome and prognosis depend on early and efficient antibiotic therapy, there is a need for sensitive and specific indicators for sepsis at the earliest stage of the disease.The clinical manifestations of neonatal sepsis are non specific and cann’t be relied on alone, also laboratory indicators such as complete blood count, I/T ratio and CRP don’t have high sensitivity especially in early sepsis.Blood cullure was the most acceptable investigator for sepsis but its report is not available before 48-72 hours.With the advent of monoclonal antibody technology that permits the measurement of the cell surface antigens the measurement of CD14+ CD16+ Monocytes which is the predominant type of monocyte during sepsis become promising test for early diagnosis of neonatal sepsis.This study aimed to evaluate CD14+ CD16+ Monocytes as an early indicator for neonatal sepsis.45 neonates were studied and were classified into three groups, each group was 15 neonates.- Group I: Included neonates with proven sepsis- Group II: Included neonates with suspected sepsis- Group III: Included healthy neonates served as control group.Each group was subdivided into 7 full term neonates (group a ) and 8 preterm neonases (group b)..Each patient was subjected to adequate history taking including ante, natal, postnatal history, thorough clinical examination and laboratory investigations that included CBC, (with special focus on (TLC, I/T, ...), CRP, Blood culture (on admission for group I and III and 2 times on admission and after 48 hours for group II and III) and measurement of percentage expression of CD16 on CD14+ Monocytes by flowcytometery.In our study the clinical findings were variable and non specific with most frequent clinical finding weak or absent reflexes in both neonates with proven sepsis and in suspected neonates who didn’t develop sepsis later on (86.7%, 57.1%) respectively.As regards blood Culture it was positive in all neonates with proven sepsis and neonats with suspected sepsis who developed sepsis later on. When repeated 48 hours from admission and it was negative in suspected neonates who didn’t develop sepsis either on admission or after 48 hours.The commonest organism was klebsiella. (39.2 %). The results were obtained at least after 48 hours from sampling.In the present study we found that prematurity affects mo. % of TLC, CD14+ CD16+ mo. % of TLC and % of gated mo. In healthy neonates, and this effect was not apparent in sepsis group while in suspected group there was significant difference as regard the previous 3 parameters plus I/T ratio, CRP and MFI of CD14+ and that is because all suspected fullterms didn’t develop sepsis and all suspected preterms developed sepsis when were followed up for 48 hours and this shows the effect of both sepsis and prematurity.Regarding HB. % and platelet count there was significant decrease in both parameters in patients with sepsis either pre or fullterms.Comparing fullterms and preterms sepsis groups with the controls, our study showed non significant decrease in TLC and ANC and the same was found in suspected group who developed sepsis.CRP was found to be significantly high in all cases of proved sepsis fullterms and preterms and in suspected neonates who developed sepsis later on. Except on admission in 4 cases of suspected neonates who developed sepsis later on and this indicates that it’s a good parameter in diagnosis of sepsis but its value is limited as a marker for early diagnosis.Sensitivity of CD14+ CD16+ mo. % of TLC (91.3%) was more than that of CRP (78.3 % also its +Ve. And –Ve. Predictive value (84%, 90%) respectively were more than that of CRP (81.8%, 78.3%) respectively.In the present study MFI of CD14 showed significant difference between the 3 groups, sepsis suspected and controle. Fullterms had non significant low level of MFI of CD14 and as regards CD14+ CD16+ mo.% of TLC it was increased significantly in neonates with proven sepsis both pre and fullterm and in suspected neonates who developed sepsis.The CD14+ CD16+ mo. % of gated mo. shows approximately the same results as CD14+ CD16+ mo% of TLC in addition it shows significant increased level in suspected preterm who developed sepsis comparing to preterm sepsis.While CD14+ CD16+ mo. % of TLC shows significant +Ve. correlation with I/T ratio and CRP, the most common parameters used for diagnosis of sepsis, the CD14 + CD16+ mo. % of gated mo. does not do. So measurement of CD14+ CD16+ % of TLC seems to be useful for early diagnosis and CD14+ CD16+ mo. % of gated mo. for early prediction of neonatal sepsis.
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