Non-septic Neonates Research Articles

The diagnostic performance of mean neutrophil volume in neonatal sepsis: A systematic review and meta-analysis

BackgroundThere is a need for reliable diagnostic tests for early identification of sepsis to prevent neonatal mortality and antibiotic misuse. During sepsis, many immature neutrophils came into the bloodstream, altering the mean neutrophil volume (MNV) shown in the previous studies. ObjectivesTo summarize the diagnostic performance of mean neutrophil volume (MNV) in neonatal sepsis from the published literature. MethodDatabases such as PubMed, Scopus, and Web of Science were searched from January 1990 to April 2023 for studies reporting MNV as a diagnostic test in neonatal sepsis. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) of the summary receiver operating characteristic (SROC) curve of MNV were estimated with reference blood culture-positive sepsis and clinical sepsis for meta-analysis. ResultThe diagnostic performance of MNV was analyzed in 1685 neonates, including 829 septic and 856 non-septic neonates, from six prospective studies. The pooled sensitivity and specificity of MNV were 0.87 and 0.75, respectively, for neonatal sepsis; the DOR was 20.01 (95% CI: 5.90–67.82); and the AUC of the SROC for MNV was 0.81 (95% CI: 0.69–0.88). Higgins I2 was 92.1% (95% CI: 85.5%–95.7%). The diagnostic performance of MNV was better during sub-group analysis of studies reporting culture-positive sepsis (DOR 85.61). ConclusionThe diagnostic performance of MNV is moderate for neonatal sepsis. As the evidence originated from a small number of studies with marked heterogeneity, further large-scale diagnostic accuracy studies are recommended to resolve heterogeneity in the future.

Diagnostic Accuracy of the Neonatal Early Onset Sepsis Calculator in Screening for Early Onset Sepsis in Neonates More Than 35 Weeks Age of Gestation

Background: Early-onset sepsis (EOS) is a leading cause of morbidity and mortality among neonates. Diagnosis of EOS can be difficult as clinical signs are subtle. The use of the Neonatal EOS Calculator (NEOSC) may help screen high-risk neonates for EOS and may result in a significant reduction in unnecessary antibiotic use. Objective: To determine the diagnostic accuracy of the NEOSC in screening for EOS in neonates more than 35 weeks age of gestation. Methodology: This was a retrospective, case-control study where 245 septic (cases) and 245 non-septic (controls) neonatal and maternal medical records were reviewed. The EOS risk classification from the NEOSC was compared with the actual clinical outcome. An online statistical software (medcalc.org) was used to compute for the sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and accuracy of the NEOSC. Results: Based on the NEOSC, only 64 of 245 clinically septic neonates were truly positive for sepsis while 181 were falsely negative for sepsis. Of the 245 non-septic neonates, 3 were falsely positive for sepsis, while 242 were truly negative for sepsis. With a 95% confidence interval, the computed variables showed a Sn 26.12%, Sp 98.78%, PPV 76.12%, NPV 89.95%, PLR 21.33, and NLR 0.75. The accuracy of the NEOSC is 89.33%. Conclusion: The NEOSC had poor sensitivity and is not recommended in screening for EOS in neonates more than 35 weeks age of gestation. It may be used as an adjunct in EOS diagnosis due to its high specificity and accuracy.

Platelet parameters as a diagnostic marker in early diagnosis of neonatal sepsis- Seeking newer answers for older problems.

ABSTRACTBackground:Early identification and intervention of neonatal sepsis can improve the clinical outcome. Blood cultures remain the gold standard for diagnosis but are not easily available and require time. There is a need to identify and validate newer easily available cost-effective investigations, which would help in the diagnosis of neonatal sepsis.Aim:To test the hypothesis that whether platelet parameters, i.e., total platelet count (TPC), mean platelet volume (MPV), and the ratio of MPV/TPC can serve as diagnostic markers in neonatal sepsis.Methods:It is was a prospective study conducted in a tertiary care neonatal intensive care unit (NICU). The platelet parameters, i.e., TPC, MPV, and MPV/TPC of blood culture-positive septic neonates were compared with those of non-septic neonates admitted to the NICU. The diagnostic accuracy of the platelet indices was assessed by receiver operating characteristics (ROC) curves and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).Result:During the study period, 43 blood culture-positive sepsis neonates were compared with 54 cases of non-septic neonates. There was a significant difference in the mean of TPC, MPV, and MPV/TPC ratio between septic groups and non-septic groups. The sensitivity, specificity, PPV, NPV values of MPV (cut-off >9 fL) were 63.40%, 53.8%, 52.0%, and 65.11% respectively. The sensitivity, specificity, PPV, NPV of MPV/TPC ratio (>7.2) were 48.8%, 96.22%, 90.9%, and 70.42% respectively. The area under the curve (AUC) values for TPC, MPV, and MPV/TPC in the ROC analysis were 0.797, 0.641, and 0.809, respectively.Conclusion:Platelet indices MPV and MPV/TPC ratio can be useful in the early diagnosis of neonatal sepsis.

Role of Serum Apelin in the Diagnosis of Early-Onset Neonatal Sepsis.

Objective:Apelin is a proinflammatory adipocyte-derived factor. The aim of this study was to evaluate the role and significance of serum apelin as a new sepsis marker in the identification of full-term and preterm new-born infants with early-onset sepsis.Material and Methods:This was a case-control study. We included 80 neonates. The cases were divided into 2 groups; neonates with early-onset sepsis and control group with neonates non-sepsis. Apelin was quantified by enzyme-linked immunosorbent assay.Results:There was a significant elevation in the mean values of serum apelin in the early-onset sepsis group (1214.7 ± 273.06 pg/mmol) than in the non-septic neonates 116.27 ± 21.96 pg/mmol (P < .0001). Apelin values were correlated to clinical sepsis and hematological scores as well as C-reactive protein. Serum apelin concentration was significantly higher among culture-positive cases than the culture-negative cases (mean ± SD was 1239.52 ± 268.47 and 929.42 ± 136.97 pg/mmol, respectively, P < .0001). Moreover, the apelin level was higher in non-survivor neonates than in the survivors in the early-onset sepsis group. No significant difference was found between preterm and full-term new-born infants with regard to the apelin values. The best cut-off estimate of apelin to diagnose early sepsis was >178.33 pg/mmol.Conclusion:Apelin may be useful in the diagnosis and prognostic prediction of neonates with early-onset sepsis.

Red Cell Distribution Width Value Supports the Diagnosis of Neonatal Sepsis in 34-42 Week Gestational Age Neonates

Introduction: Neonatal sepsis is an emergency because delayed treatment can be fatal, whereas the diagnosis is challenging because of the unspecific clinical manifestation. Bacterial culture is the gold standard for the diagnosis, but it takes several days to get the results, which often come out as negative. This study aims to determine the diagnostic value of RDW to support the diagnosis of neonatal sepsis in 34 – 42 week gestational age neonates. Methods: This cross-sectional diagnostic study used secondary data obtained from Medical Record Installation and Clinical Pathology Laboratory of Dr. Mohammad Hoesin General Central Hospital in Palembang, Indonesia. One hundred and thirty-four medical records were statistically analysed using Med Calc Version 19 to determine the cut-off point and diagnostic value of RDW in the diagnosis of neonatal sepsis. Results: One hundred and thirty-four subjects consisting 32 septic neonates (23.9%) and 102 non-septic neonates (76.1%) were reviewed. Most of them were males (80/134) and preterm (73/134) with normal birth weight (99/134). At the cut-off point of &gt; 16.2%, RDW value was significantly able to predict neonatal sepsis (p = 0.000, p &lt; α) with prediction power (AUC) of 0.780 (fair). The diagnostic values were sensitivity 84.37%, specificity 57.84%, positive predictive value 38.57%, negative predictive value 92.19%, positive likelihood ratio 2.00 and negative likelihood ratio 0.27. Conclusions: Red cell distribution width value might potentially be used as a diagnostic marker to support the diagnosis of neonatal sepsis in 34 – 42 week gestational age neonates. However, further study is needed to support this statement.

Procalcitonin and C-reactive protein for diagnosing post-operative sepsis in neonates.

To determine whether serum procalcitonin (PCT) or C-reactive protein (CRP) can diagnose post-operative sepsis among neonates undergoing major non-cardiac surgery. In this diagnostic study, we included neonates who underwent major non-cardiac surgery and were monitored for post-operative sepsis. We excluded pre-existing septic, inflammatory or life-threatening conditions. Subjects either had 'definite' (culture-positive, n=14), 'probable' (clinical sepsis, culture-negative, n=25) or no sepsis (n=31). We measured serum CRP and PCT at 48 ± 6h, 72 ± 6h and 96 ± 6h post-operatively and compared 'definite or probable sepsis' with 'no sepsis'. Median (Q1, Q3) CRP (mg/L) in 'definite or probable' sepsis group was higher than 'no sepsis' at 72 h (91.48 (57.87, 143.50) vs. 51.32 (33.0, 80.1); P=0.009) and 96 h (87.51 (45.19, 128.22) vs. 31.00 (25.3, 45.2); P < 0.001). Median (Q1, Q3) PCT (ng/mL) in 'definite or probable' sepsis was higher than 'no sepsis' at 72 h (4.22 (2.04, 12.73) vs. 1.78 (0.9, 6.4); P=0.01) and 96 h (3.54 (1.96, 9.65) vs. 0.97 (0.4, 3.0); P < 0.001). Ninety-six-hour CRP and PCT cut-offs (based on Youden's index) were 74.16 mg/L and 1.65 ng/mL, respectively. If both CRP and PCT were positive, specificity was 100% (95% confidence interval: 88.78-100). If either one was positive, sensitivity was 88.89% (95% confidence interval: 73.94-96.89). Septic neonates have significantly higher serum CRP and PCT compared to non-septic neonates at 72 and 96 h post-operatively. If both CRP and PCT are positive at 96 h after surgery, it has 100% specificity, and if either one is positive, 89% sensitivity.

Paraoxonase (PON)-1 activity in septic neonates: One more arrow in the quiver of biomarkers of neonatal sepsis?

Paraoxonase-1 (PON-1), a calcium ion-dependent high-density lipoprotein (HDL)-associated enzyme, has been proposed as a negative acute phase reactant biomarker in animal and human adult studies. The aim of this study was to evaluate the value of PON-1 activity in the diagnosis and monitoring of neonatal sepsis. Serum PON-1 activity, as paraoxonase and arylesterase, was prospectively studied in 48 septic neonates and matched controls. PON-1 activity was decreased at the acute phase of sepsis in comparison with values at recovery and values in controls. Paraoxonase or arylesterase at enrollment correlated significantly with serum Amyloid-A, CRP and IL-6 and could also discriminate septic than non-septic neonates. In conclusion, our results are promising regarding the role of PON-1 as a biomarker of neonatal sepsis. Larger studies are needed to validate the clinical utility of PON-1 in neonatal medicine.

The Utility of the Neutrophil-Lymphocyte Ratio as an Early Diagnostic Marker in Neonatal Sepsis.

AimTo find the diagnostic utility of the neutrophil to lymphocyte ratio (NLR) in the early diagnosis of neonatal sepsis.MethodologyThe case records of all blood culture-positive septic neonates admitted from January 2018 to December 2018 were reviewed. Total leucocyte count, absolute neutrophil count, absolute lymphocyte counts, NLR, and C-reactive protein (CRP) of septic neonates were compared with gestational age-matched nonseptic neonates by an unpaired t-test. The diagnostic performance of NLR and CRP was analyzed by receiver operating characteristic (ROC) analysis.ResultA total of 41 blood culture-positive neonates and 52 nonseptic neonates were enrolled in this study. There was no significant difference in the total leucocyte count and absolute neutrophil counts of septic and nonseptic neonates. The mean absolute lymphocyte count of septic neonates (2795±1424/cumm) was significantly lower than that of nonseptic neonates (4449±1794/cumm; p=<0.001). The mean NLR of septic neonates (3.88±1.78) was significantly higher as compared to nonseptic (2.3404 ±1.98) neonates (p=0.045). For the diagnosis of sepsis, NLR at cutoff >1.7 had a sensitivity and specificity of 68.3% and 46.2%, respectively; CRP at cutoff >6 mg/dl had sensitivity and specificity of 78.05% and 92.31%, respectively. In the ROC analysis, the area under the curve (AUC) for CRP and NLR for the diagnosis of neonatal sepsis was 0.918 (p=<0.001) and 0.623 (p=0.042), respectively.ConclusionBlood culture-positive septic neonates had significantly higher NLR as compared to nonseptic neonates. However, when compared to CRP, NLR was not found to be a better predictor of sepsis in our study.

Fast I(n)dentification of Pathogens in Neonates (FINDPATH-N): protocol for a prospective pilot cohort study of next-generation sequencing for pathogen identification in neonates with suspected sepsis

IntroductionSepsis is a major source of morbidity and mortality in neonates; however, identification of the causative pathogens is challenging. Many neonates have negative blood cultures despite clinical evidence of sepsis....

The diagnostic role of soluble triggering receptor expressed on myeloid cells-1 and procalcitonin for early detection of neonatal sepsis

Background/aim Sepsis is a substantial cause of death in neonates less than or equal to 28 days of life. As the bacteriologic method needs much time and it may give false-negative results in septic neonates’ diagnosis, the present study aims to appraise the diagnostic role of both soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and procalcitonin (PCT) for early detection of neonatal sepsis. Patients and methods This case–control study included 40 septic neonates and other 40 nonseptic neonates as control. They were subjected to history taking, full clinical examination, and assessment of sTREM-1, PCT by ELISA, C-reactive protein in serum, in addition to CBC and blood culture test. Results sTREM-1 and PCT showed significant increase in septic group when compared with controls. Moreover, their levels were significantly higher in positive blood culture septic neonates than negative blood culture septic neonates. C-reactive protein level was significantly higher in late-onset sepsis group than early-onset sepsis group. Conclusion Serum sTREM-1 and PCT could be used as new biomarkers for rapid and early detection of neonatal septicemia, leading to prompt initiation of antibiotic therapy for achieving better outcomes in those cases.

Endocan - a potential diagnostic marker for early onset sepsis in neonates.

Neonatal early onset sepsis assessment is based on the history of pregnancy and delivery and nonspecific clinical signs. None of the biomarkers currently in use for clinical practice has adequate prognostic value, so it is not possible to clearly distinguish neonates with culture-proven sepsis from those with only risk factors or clinical suspicion. Endocan is an endothelial mediator involved in the inflammatory response that is present in low concentrations in the serum of healthy subjects, and in much higher concentrations in patients with SIRS and septic shock. The purpose of this study is to evaluate the utility of serum endocan serum levels as a biomarker for the diagnosis of neonatal early onset sepsis (EOS). Serum endocan concentration was measured in newborns with clinical suspicion of EOS admitted to the Neonatal Intensive Care Unit on day 1, 3 and 7. Serum endocan levels were significantly increased in septic compared to non-septic neonates in the early stages of sepsis (2.43 ± 0.95 vs. 1.77 ± 0.57, p = 0.004), continued to rise up to 72 hours from onset and then decreased by the seventh day under treatment. These results suggest a potential role for endocan as an early marker for diagnosis and follow-up in neonatal EOS. Studies on a larger number of cases are needed in order to establish the practical utility of this molecule as a diagnostic tool for clinical practice.

Value of Endocan in Diagnosis and Prognosis of Neonatal Sepsis

Sepsis is one of the most common causes of morbidity and mortality in the newborn. Early diagnosis and treatment is vital to improve outcome. Investigate the possible role for endocan in the diagnosis of neonatal early onst sepsis. 40 children were included in the study, 20 septic and 20 controls, all patients were subjected to full history and clinical assessment and labouratory tests as CBC, CRP and serum level of endocan by ELISA. Results: Neonatal Sepsis group showed significantly higher Endocan when compared to control group (p < 0.001),ROC curve of Endocan level was conducted for discrimination between neonatal sepsis cases and control groups. Endocan showed AUC (AUC=0.758). At cut off value of 21.4, sensitivity was 70%, specificity was 78.3%, PPV was 74.5%, NPV was 68.1%, accuracy was 70.8%. Serum endocan levels are significantly increased in septic compared to non-septic neonates in the early stages of sepsis. We suggest that endocan is an effective, reliable, and promising new biomarker for detecting neonatal sepsis.

Measurements of C-Reactive Protein for Successful Management and Follow-Up Treatment of Neonatal Sepsis and Nosocomial Infection

Objective: To develop an optimal follow-up treatment for neonatal and nosocomial infections and to examine correlations between the C-reactive protein (C-RP) and platelets. Methods: A sample of 27 septic neonates and 14 non-septic neonates were selected for this study. The non-septic neonates served as a control group. Blood samples were collected from both groups and analyzed for bacterial contamination via blood culture, complete blood count (CBC), and C-RP, according to international laboratory standards. Blood collection and analysis were repeated every day during the follow-up treatments with antibiotics to evaluate the kinetics of C-RP. Results: Blood culture found E. coli and Staphylococcus aureus in the blood of the septic cases. Serum C-RP concentrations were at high levels (24 mg/dl) in the septic neonates and at normal levels (lower than 6 mg/dl) in the control group. Treatment with active antibiotics resulted in a drastic reduction of the C-RP values and helped to reach a normal level as in the control group. On the other hand, there were increases in the platelet levels as the C-RP levels decreased. This result indicates a strong negative association between C-RP and platelet levels in the septic group only. Statistical analysis shows significant differences between the mean C-RP serum concentrations of the sepsis and non-sepsis. Conclusion: blood culture, active antibiotics, and kinetic C-RP measurements during the medical follow-up treatment are strong driving parameters for the optimal and successful management of sepsis.

Stromal-derived factor-1 (CXCL12) and its receptor (CXCR4) in neonatal sepsis

Background Neonatal sepsis remains a major cause of morbidity and mortality in newborns. The C-X-C motif chemokine 12 (CXCL12) and its receptor α-chemokine receptor type 4 (CXCR4) are now known to play an important role in inflammatory states and mediate lymphocyte migration in response inflammation. However, it is unclear how chemokines respond to late-onset neonatal sepsis (LOS). Objective The aim of this study was to assess the value of measuring the serum levels of stromal-derived factor-1, also named CXCL12, and lymphocyte expression levels of its receptor CXCR4 in the diagnosis of LOS in relation to clinical and hematological sepsis scores. Patients and methods Levels of CXCL12 in serum and lymphocyte expression of CXCR4 were determined using enzyme-linked immunosorbent assay technique and flow cytometry, respectively, in 38 full-term neonates; 23 cases of LOS (13 male and 10 female) and 15 healthy neonates (six male and nine female) were included in the study. Results Serum levels of CXCL12 and lymphocyte expression levels of CXCR4 were significantly higher in neonates with LOS when compared with nonseptic neonates. At a cutoff point of 30 pg/ml, the diagnostic accuracy of CXCL12 in the diagnosis of neonatal sepsis was 100%, with a sensitivity of 100% and a specificity of 100%, whereas the diagnostic accuracy of mean fluorescence intensity of lymphocyte expression of CXCR4 in the diagnosis of neonatal sepsis was 84%, with a sensitivity of 87%, specificity of 80%, positive predictive value of 87%, and negative predictive value of 80% at a cutoff point of 150. Conclusion CXCR4 and CXCL12 levels increase significantly in septic neonates and they are valuable markers in the diagnosis of neonatal sepsis.

Association of vitamin D deficiency with an increased risk of late-onset neonatal sepsis

Background: Vitamin D deficiency in mothers and neonates is being recognised increasingly as a leading cause of many adverse health effects in the newborn infant, including sepsis.Methods: A prospective observational study was conducted at a tertiary care Paediatric teaching hospital in northern India to assess vitamin D deficiency as a possible risk factor for late-onset sepsis (LOS) in term and late preterm neonates and also to examine the correlation between maternal and infant vitamin D levels during the neonatal period. Late-onset sepsis (LOS) was defined as the development of signs and symptoms of severe sepsis after 72 h of life and a positive sepsis screen. All term and late preterm neonates admitted with LOS between September 2015 and February 2016 who had not been previously admitted for >48 h and had not been prescribed antibiotics or vitamin D were included in the study. Matched controls were recruited from otherwise healthy neonates admitted with physiological hyperbilirubinaemia. Serum 25(OH) vitamin D was assessed in neonates in both groups and their mothers.Results: A total of 421 neonates were admitted to the neonatal intensive care unit during the study period, 120 of whom satisfied the inclusion criteria, and 60 were recruited as cases. Sixty neonates were recruited as controls who were similar in gender, gestational age, age at admission and anthropometry. The study group had significantly lower mean (SD) vitamin D levels [15.37 ng/ml (10.0)] than the control group [21.37 ng/ml (9.53)] (p = 0.001). The odds ratio was 1.7 (95% CI 0.52–5.51) for LOS in vitamin D-deficient neonates. Mothers of septic neonates also had significantly lower mean (SD) vitamin D levels [17.87 (11.89)] than the mothers of non-septic neonates [23.65 ng/ml (9.55)] (p = 0.004). Maternal vitamin D levels strongly correlated to neonatal vitamin D levels in both groups.Conclusion: Neonates with vitamin D deficiency are at greater risk of LOS than those with sufficient vitamin D levels.

Can we rely on the neutrophil left shift for the diagnosis of neonatal sepsis? Need for re-evaluation

BackgroundNeonatal sepsis cause significant morbidities and mortality among affected neonates. The gold standard for its diagnosis is the blood culture. However, its usefulness is limited by many factors. A rapid diagnostic test with high sensitivity and specificity is needed for rapid identification of neonatal sepsis without exposing unaffected neonates to antibiotic therapy. The accuracy of immature neutrophil count for the diagnosis of neonatal sepsis is controversial. ObjectiveBeing rapid, simple and readily available, this study aimed to re-evaluate the usefulness of neutrophil left shift for the diagnosis of neonatal sepsis and assess its prognostic value in reflecting the patients’ outcome. MethodsThis prospective cross-sectional study included 285 neonates admitted to the neonatal intensive care unit, Cairo University. Demographic, clinical and laboratory data were collected including complete blood pictures with manual differentials and blood culture results. The diagnostic accuracy of neutrophil left shift was done through applying multiple logistic regression and receiver operating characteristic [ROC] curve. ResultsAmong the study group, 61.4% had definite sepsis while 12.3% had probable sepsis. The median immature to total neutrophil ratio (I/T ratio) was 0.25, IQR 0.21, range 0.03–0.8. I/T ratio ≥ 0.2 was present in 65.6% of the patients and had significantly increased odds of infection, sensitivity (82.4%), specificity (81.3%), positive predictive value (92.5%) and negative predictive value (62.2%). By plotting neutrophil left shift against blood culture, total white blood cell count (WBC) and platelet count in a ROC curve and calculating areas under the curve (AUC), it proved to be a good diagnostic test (AUC: 0.861) while total WBC count (AUC: 0.515) and platelet count (AUC: 0.366) had poor diagnostic accuracy. ConclusionNeutrophil left shift is a rapid, simple and readily available test that has a reasonable positive predictive value and specificity which denotes its usefulness in the early diagnosis of neonatal sepsis as well as in decreasing the exposure of non-septic neonates to antimicrobial therapy.

Endocan and Soluble Triggering Receptor Expressed on Myeloid Cells-1 as Novel Markers for Neonatal Sepsis

Neonatal sepsis is an important cause of neonatal morbidity and mortality in the neonatal intensive care unit. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) has been evaluated in sepsis and septic shock, and it was found to be valuable in distinguishing septic cases from nonseptic cases. Endocan is constitutively expressed by endothelial cells, and high levels of endocan may be of relevance for the promotion of systemic inflammation. The aim of this study was to investigate whether the levels of sTREM-1 and endocan were increased in late-onset neonatal sepsis. Patients were classified into septic and nonseptic groups. Blood was collected from a peripheral vein of all septic newborns and healthy newborns at the time of initial laboratory evaluation before any treatment, and within 48-72 hours after initiation of treatment. Serum sTREM-1 and endocan measurements were performed when the study was finished. The study population comprised of 50 neonates: 20 nonseptic neonates and 30 septic neonates. The groups were similar with regards to baseline characteristics. The initial measurements of interleukin-6 (IL-6), sTREM-1, endocan, and immature/total neutrophil ratio (I/T ratio) were significantly higher in septic neonates in comparison with nonseptic neonates. Receiver operating characteristic (ROC) curve analyses revealed that IL-6, sTREM-1, endocan, and I/T ratio resulted in significant areas under the curve (AUC) with respect to early identification of septic neonates. Soluble TREM-1 and IL-6 performed best to distinguish septic neonates from nonseptic neonates. Univariate logistic regression analysis showed that increased IL-6 and sTREM-1 were strong predictors of neonatal late-onset sepsis. Serum sTREM-1, IL-6, endocan levels, and I/T ratio increased in septic neonates. However, the diagnostic accuracy of circulating sTREM-1 seemed to be better than endocan and I/T ratio, but lower than IL-6.

Increased myeloperoxidase activity as an indicator of neutrophil-induced inflammation and sepsis in neonates

Background: MPO is an enzyme that contains heme secreted by phagocytic cells after the respiratory burst system activation. MPO is expressed mainly by neutrophils and monocytes in small quantities and it is very important to determine further process of hydrogen peroxide. Objective: to evaluate neutrophils activation and the MPO enzyme activity in plasma as an indicator of sepsis as well as sepsis severity in neonates with sepsis with correlation to their clinical and laboratory findings. Methods: were classified into 2 groups: sepsis group: included 45 neonates with gestational ages 28-40 weeks with sepsis, 15 of them had been subjected to follow up samples, control group: included 30 neonates proved to be free of sepsis. All neonates were subjected to history taking, clinical examination and measurement of plasma MPO enzyme. Results: this study revealed that MPO activity and neutrophil cell count are increased in sepsis group compared to the non-septic neonates. The ROC curve showed that the best cut off for MPO in prediction of septic patients and mortality was found >54 mu/ml and >83 mu/ml respectively. There was positive correlation between MPO enzyme activity and the total leukocyte count and neutrophil count. By following up some of sepsis group neonates there was significant decrease in MPO activity goes along with improvement in clinical state of neonates with sepsis. MPO enzyme activity was found to be low in septic shock patients who also have pancytopenia compared to septic patients without shock. Conclusion: plasma MPO enzyme proved to be a good marker of sepsis in neonates, with a good prognostic value in severe cases. Keywords: MPO, inflammatory response, neonates, sepsis

Plasma Neutrophil Gelatinase Associated Lipocalin in Neonates With and Without Sepsis

Background: Plasma neutrophil gelatinase associated lipocalin (NGAL) level is increased in sepsis irrespective of renal dysfunction. We investigated the effect of sepsis on the plasma level of NGAL in neonates. Objectives: The aim of this study was to find whether serum NGAL is a reliable marker for early diagnosis of sepsis in neonates. Patients and Methods: We conducted a prospective observational study in a university hospital neonatal intensive care unit. Serum NGAL was measured in 120 neonates admitted to the neonatal intensive care unit. Neonates were classified according to the presence of sepsis. Fifty-two Patients had sepsis. Results: The NGAL levels were significantly higher in septic neonates compared with non-septic neonates (102.9 ± 69.9 ng/mL versus 29.2 ± 13.3 ng/mL, P value = 0.0001). An optimal cut off-point of 48 ng/mL for serum NGAL could potentially detect neonates with sepsis with a sensitivity and specificity of 92% and 91%, respectively. Conclusions: Sepsis enhances the production of plasma NGAL in critically ill neonates. Thus Plasma NGAL can help clinicians diagnose sepsis in critically ill neonates during early phases.

Usefulness of the delta neutrophil index for assessing neonatal sepsis

We investigated the significance of the calculated delta neutrophil index (DNI) as a diagnostic factor for neonatal sepsis. In retrospective study, 24 infants were diagnosed with blood culture-proven sepsis, and 48 non-septic neonates matched for gestational age, and birth weight served as controls. Among the 24 infants with sepsis, 5 died within 7 days at diagnosis. Mean DNI (at diagnosis, after 24 h and 72 h), CRP and WBC counts were significantly higher, and neutrophil and platelet counts were significantly lower in sepsis group than control group. In sepsis group, mean DNI at the time of diagnosis, DNI at 72 h, and CRP at 72 h were significantly higher, and platelet counts were significantly lower for patients with sepsis who died compared with those who survived. In multiple logistic regression analysis, mortality in neonates with sepsis significantly correlated with DNI at 72 h (OR 1.47, 95% CI 1.1-5.6, p = 0.032) and with platelet count (OR 0.93, 95% CI 0.51-0.99, p = 0.014). ROC analysis for DNI at 72 h revealed a cut-off value of 12%, which predicted mortality with 81% sensitivity and 87% specificity. DNI may be a valuable tool in assessing the prognosis of patients with neonatal sepsis.