الفهرس 
Alpha -1-. Acid GlycoproteinOnly 14 pages are availabe for public view
 |  | from | 97 |  |  |
| | | from | 97 | | |
Abstract
Neonatal sepsis remains a major clinical problem in neonatology, with high morbidity and mortality rates despite the progress in neonatal intensive care and antibiotics. The diagnosis of neonatal sepsis begins with clinical suspicion. Unfortunately there is no single diagnostic test, which can reliably diagnose sepsis in the newborn, therefore many diagnostic tests are utilized to diagnose or confirm sepsis. This work was designed to evaluate the diagnostic value of α 1-acid glycoprotein (α1AGP) in the early diagnosis of neonatal sepsis and compare this value with other diagnostic tests as C-Reactive Protein (CRP) and blood culture. The study included 80 neonates: Patients group included 60 neonates according to inclusion criteria of clinical and hematological sepsis score and classified according to blood culture. GROUP Іa (confirmed sepsis ): included 40 newborns with positive blood culture GROUP Іb ( clinical sepsis ) : included 20 newborns with negative blood culture. Control group included 20 neonates apparently healthy as a control group from the follow up clinic of the same range of postnatal age gestational age and of the same socioeconomic status . All the studied groups were subjected to the following: 1.History taking.( prenatal, natal and postnatal history taking that included intrapartum fever > 38°C.,intepartum hemorrhage, premature rupture of membranes 18 hours,difficult labour,mode of delivery. 2.Thorough clinical examination. 3. Laboratory investigations including: Complete blood count including indices using Sysmex KX21. Blood cultures for isolation of the causative organism and its identification using BACTEC 9050 Quantitative measurement of CRP. Quantitative measurement of Alpha 1- acid glycoprotein(α1AGP) by immunoturbidimetry. Concerning the demographic criteria in the studied groups, there is no significant difference between the studied groups as regards the gestational age (P>0.05) and postnatal age (P>0.05). Also a male predominance was found in the studied groups as males represents 55% of the patients group. As regarding natal history between studied groups, the mode of delivery show no statistical difference between the studied groups and the most frequent risk factors were premature rupture of membranes (PROM)more than 18 hours were found in 45% of cases As regarding the clinical presentations , the most common clinical findings among patients with proven sepsis was weak sucking in 90%of cases followed by lethargy in 70%, weak Moro in 70%,25% of cases had respiratory distress, 25% of cases had apnea ,15% of cases had hepatosplenomegally, 25% of cases had abdominal distension, ,15% of cases had convulsions and sclerema was present in 10% of cases. As regard hematological data in studied groups the hemoglobin concentration was highly statistical significant difference between patients Ia and patients Ib (p<0.001), highly statistical significant difference between patients Ia and control group (p<0.001)and statistical significant difference between patients Ib and control group (p<0.05) ,and as regard total leucocytic count was highly statistical significant difference between patients Ia and patients Ib (p<0.001), highly statistical significant difference between patients Ia and control group (p<0.001) and statistical significant difference between patients Ib and control group (p<0.05)and as regards platelet count there is highly statistical significant difference between patients Ia and patients Ib group (p<0.01),no statistical significant difference between patients Ia and control group (p>0.05)and statistical significant difference between patients Ib and control group (p<0.05). In our study, the cases which had I/T ratio of more than 0.2 represented 100% in the patients groups and this is attributed to the release of neutrophils from bone narrow in response to infection, with increasing number of immature cells entering the blood stream and producing a differential cell count with ashift to the left. The difference between the two groups was highly statistical significant difference (P< 0.001).Results of blood cultures in the septic neonates showed that 37.5%were caused by Staph., 27.5% were caused by Klebsiella, 17.5% were caused by E.coli , 12.5% were caused by Pseudomonous. And 5% were caused by Streptococcus. CRP level was found to be positive (≥6mg/l) ,100% in patients group Ia, 75%in patients group Ib, and 5% in control group and showed highly statistical significant difference between patients Ia and control groups(p<0.001) and highly statistical significant difference between patients Ib and control groups (p<0.001). CRP was done at admission and after 24hr and there is no statistical significant difference between patients Ia and patient Ib groups as regard CRP at admission.(p>0.05) and statistical significant difference between patients Ia and patients Ib groups as regard CRP after hours.(p<0.05) and as regard the CRP sensitivity in patients groups was 91.7% and the CRP specificity in patients groups was 95.00% and as regard positive predictive value in patients groups was 98.2% and and as regard negative predictive value in patients groups was 79.2% and the cut off valueof CRP 6 mg ∕ l . Serum level of α1-AGP was found to be in the patients group Ia at admission range(101-504),mean ±SD (264.12± 126.08) and after 24 hrs range(270-850)mean ±SD (488.22± 159.57) and in patients group Ib at admission range(104-340) mean ±SD (171.10± 52.56)and after 24 hrs range(231-581)mean ±SD (351.45± 81.59) this show highly statistical significant difference between Patients Ia and patients Ib groups as regarding α1AGP (p<0.01)highly statistical significant difference between patients Ia and control groups as regarding α1 AGP (p<0.001) highly statistical significant difference between patients Ib and control groups as regarding α1 AGP (p<0.001). In our study we found the sensitivity of α1 AGP in patients group was 91.7% and as regard specificity in patients group was 100% and as regard positive predictive values of α1-AGP in patients was 100.00%and as regard negative predictive values of α1-AGP in patients group 80.00% . The cut off value of α1AGP 123.5mg ∕ dl. ROC curve analysis shows that α1AGP is better than CRP as an early marker of neonatal sepsis.but its high specificity is accompanied with low sensitivity. So single test of α1AGP is of limited value in the early diagnosis of neonatal sepsis. In conclusion, CRP is of limited value as a diagnostic marker in the early diagnosis of neonatal sepsis but its high specificity was accompanied with low sensitivity. values showed high sensitivity in the 2nd test (after 24hrs),so we suggest that repeated α1AGP tests can be used but a single test for α1AGP would have limitations in the neonatal sepsis which requires rapid diagnosis.