الفهرس 
NEONATAL SEPSISOnly 14 pages are availabe for public view
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Abstract
We aimed to assess the expression of TLR4 on monocytes in neonates with risk factor (s) of infection who may develop sepsis in comparison to healthy neonates in order to assess its value in early diagnosis of early-onset neonatal sepsis before the results of blood culture, which are available after 48 hours, for the early start of the antibiotic therapy, if needed, in those patients. Another important aim was to assess the value of this marker in exclusion of sepsis in high risk neonates to avoid the unnecessary use of antibiotic therapy.
The study was carried out in the NICU of Kafr-El-Shiekh General Hospital and the Clinical Pathology Department in Ain Shams University Hospitals. It included 40 neonates, 20 of them were admitted to NICU due to signs of possible sepsis and the other 20 neonates had no clinical or laboratory findings suggestive of sepsis and were serving as controls. Patients were divided into 2 groups according to the results of blood culture; sepsis group which included 13 neonates who had few clinical manifestations, which may suggest sepsis at the time of initial evaluation, that is confirmed by evident clinical manifestations and positive blood culture after 48 hours and no infection group which comprised 7 neonates with few clinical manifestations, which may suggest sepsis at the time of initial evaluation. Sepsis was ruled out by negative blood culture and absence of clinical manifestations of sepsis after 48 hours. The studied neonates were sampled initially at the time of admission. A second, follow-up, sample for further evaluation of the studied laboratory markers of sepsis was taken after 48 hours.
At the time of initial evaluation of the studied neonates, there was a highly significant increase of the levels of Mo. expressing TLR4%* and MFI of sepsis group in comparison to both no infection and control groups (P < 0.001 for all). In contrast, patients with no infection and healthy controls had comparable levels of Mo. expressing TLR4%* and MFI.
Interestingly, all the patients with neonatal sepsis and none of the patients without sepsis had elevated levels of Mo. expressing TLR4%* and MFI above the calculated cut-off values obtained from ROC curve.
At 48 hours, after the time of initial evaluation of the patients, there was also a significant increase of levels of Mo. expressing TLR4%* and MFI of sepsis group in comparison to both infection and control groups.
The 48 hours follow-up did not reveal a significant increase of the levels of either Mo. expressing TLR4%* or MFI in both patients with neonatal sepsis and without sepsis.
There was no statistically significant difference between the three groups regarding sex, body weight and gestational age
There were significant negative correlations between Mo. expressing TLR4%*, and weight of the patients with neonatal sepsis (P=0.029). In addition, MFI showed significant negative correlations with age (P=0.035) and CRP (P=0.033) and a significant positive correlation with Hb% (P=0.041).
Both Mo. expressing TLR4%* and MFI had 100% and 100% sensitivity, respectively and 100% and 100% specificity, respectively in differentiation of neonatal sepsis from healthy condition and differentiation of neonatal sepsis from possible infection condition at their best calculated cut-off values obtained from ROC curve.
CRP had only 38.5% sensitivity in differentiation of neonatal sepsis from healthy and no infection groups, while it had 90% and 89% specificity in differentiation of neonatal sepsis from healthy and no infection groups, respectively.
Hematologic score had 100% sensitivity in differentiation of neonatal sepsis from healthy and no infection groups, while it had 70% and 67% specificity in differentiation of neonatal sepsis from healthy and no infection groups, respectively. Thus, both Mo. expressing TLR4%* and MFI had higher sensitivity and specificity than the other routine parameters used in diagnosis of neonatal sepsis. Thus, both Mo. expressing TLR4%* and MFI had higher sensitivity and specificity (100% for both) than the other routine parameters used in diagnosis of neonatal sepsis.
In conclusion, Mo. expressing TLR4%* and MFI are better predictors of neonatal sepsis than other routine laboratory parameters of this disease. This may help in the early diagnosis of the disease before the results of blood culture, which are available after 48 hours, for the early start of the antibiotic therapy. Moreover, these markers may be good parameters that can exclude sepsis in high risk neonates with possible infection. This is equally important to avoid the unnecessary use of antibiotics to avoid their cost and side effects.