الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 134 |  |  |
| | | from | 134 | | |
Abstract
Despite improved neonatal care over the past decades, infections remain common and sometimes life-threatening in neonates admitted to the neonatal intensive care unit (NICU).The diagnosis of neonatal sepsis begins with clinical suspicion. The challenge for the neonatal practitioner is to decide which babies need empirical antibiotic therapy but this causes antibiotic overuse and nosocomial infections because of unnecessary hospitalization. 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 study was conducted in order to evaluate the diagnostic value of CRP and Alpha 1- acid glycoprotein (α1AGP) in the early diagnosis of neonatal sepsis.
This study was conducted on 35 neonates presenting with symptoms and signs suggesting neonatal sepsis, admitted to NICU of EL-Radwan Hospital ,Ain shams. In addition, 20 healthy neonates as control group.
Weak suckling, weak Moro, lethargy and respiratory distress were the commonest presentation of sepsis in our study followed by GIT manifestations and convulsions, while sclerema and bleeding tendency were the least presentation of sepsis.
Our study reveals no significant difference regarding TLC between patients and control groups.
On the other hand, highly significant increase regarding I/T ratio was observed in the patients group when compared with that of the controls.
It shows significant difference regarding HB level and platelete count between patients and control groups.
Results of blood cultures in the septic neonates showed that Staph., E.coli and Streptococcus were the most frequent.
In our study CRP level was found to be very significant statistically between septic group and control groups. The 2nd test of CRP levels was significantly higher than the 1st test results.
In this study, at a cut off point of CRP 3 mg /l. the sensitivity was 68.5 in 1st test, increased to 94.2% in 2nd test, the specificity was 90% in 1st &2nd tests, positive predictive value (PPV) was 92.3% 1st test,increased to 94.2%in 2nd test and negative predictive value (NPV) was 62%1st test, increased to 90% in 2nd test.
In our study, serum level of α1-AGP was found to be very significant statistically between septic group and control group. There is significant increase in α 1 AGP in septic neonate. The 2nd test of AGP levels were significantly higher than the 1st test results so, serial measurement is useful.
In the current study, at a cut off point of AGP 155 mg /dl, the sensitivity was 80% in 1st test, increased to 91% in 2nd test, the specificity was 95%in 1st &2nd tests, positive predictive value (PPV) was 96.5%1st test, increased to 96.9% in 2nd test and negative predictive value (NPV) was 73%1st test, increased to 86.3%in 2nd test.
AGP has high specificity ,high sensitivity and high PPV&NPV in 1st test in comparison to CRP (1st test) but has high specificity relatively low sensitivity in comparison with CRP (2nd test). ROC curve analysis shows that α1AGP is better than CRP as an early marker of neonatal sepsis. The 2nd test of alpha 1-AG values resulted with high sensitivity, we suggest that serial alpha1AG tests seems to be more useful than single test in diagnosis of neonatal sepsis.