Serum polymorphonuclear leukocyte elastase enzyme level in neonatal sepsis

Abstract

Objective The aim of this study is to evaluate the clinical importance of polymorphonuclear leukocyte (PMN) elastase level in neonatal sepsis. Background Neonatal sepsis is defined as a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first 4 weeks of life. When pathogenic bacteria gain access into the bloodstream, they may cause overwhelming infection without much localization (septicemia) or may be predominantly localized to the lung (pneumonia) or the meninges. Patients and methods This prospective study was performed on 60 newborns, which included 30 newborns with positive clinical sepsis score and 30 healthy neonates matched for age, sex, and weight as a control group. Blood samples for blood culture, routine biochemistry, whole blood count, immature neutrophil: total neutrophil ratio, C-reactive protein, and PMN elastase were taken. Antibiotics were commenced after the blood specimens were collected. Second blood samples for sepsis markers were obtained from the patient only on the fourth day of treatment. Results In our study, we found that respiratory distress was the most common clinical presentation (86.7%) in neonates with sepsis followed by poor activity (83.3%) and jaundice (40%). PMN elastase levels in neonates with sepsis were highly significantly increased compared with controls. Overall, 100% of patients had a positive PMN elastase test result, and PMN elastase has a sensitivity of 96% and positive predictive value of 86% in prediction of sepsis. The sensitivity of C-reactive protein in detecting sepsis was 77%, specificity was 93%, positive predictive value was 87%, and negative predictive value was 14%. Conclusion These findings indicate that PMN elastase level is a major indicator for the early diagnosis of sepsis in newborns.