The use of hepcidin and presepsin in diagnosis of neonatal sepsis and its neurological sequelae in a tertiary neonatal intensive care unit, Assiut, Egypt

Abstract

Background Neonatal sepsis (NS) is a common neonatal disorder associated with high mortality and morbidity. Objective The present work aims to assess diagnostic value of hepcidin and presepsin in NS detection and their roles in associated morbidity (especially neurological defects) and mortality. Patients and methods A case–control study was conducted at the neonatal intensive care unit of University Children’s Hospital, Assiut, Egypt, in the period between June 2018 and June 2019. A total of 120 neonates with NS and 40 healthy neonates as control group were enrolled. Neonates were subjected to full history taking and thorough clinical evaluation. Blood picture, C-reactive protein (CRP), blood culture, and hepcidin and presepsin serum levels were measured. Only survivors were subjected to electroencephalography (EEG) and brain computed tomography (CT) evaluations. Results Neonates in NS group had significantly higher CRP, as well as hepcidin and presepsin serum levels versus control. Hepcidin and presepsin were significantly higher among nonsurvivors versus survivors and in neonates with neurological deficits versus neonates without neurological deficit. Sensitivity and specificity were 88.33 and 82.50%, respectively, for CRP; 93.33 and 90.00%, respectively, for hepcidin; and 91.67 and 90.00%, respectively, for presepsin. Of NS group, 66.7% had late-onset sepsis, 20.0% had neurological deficits, and 45.0% were survivors. Among survivors, the most frequent findings in EEG were focal epileptic discharge (57.4%) followed by continuous normal voltage (46.3%), and generalized periodic discharge with triphasic waves (42.6%), whereas in CT, the most frequent findings were mild hypoxia (37.0%) followed by periventricular hypoxia (33.3%). Conclusions Hepcidin and presepsin have an important role in prediction and diagnosis of NS with neurological sequelae and death. Moreover, brain CT and EEG must be performed in all survivor neonates following NS.