Doppler Cerebral Blood Flow Measurements, Serum Neuron-Specific Enolase and Neurodevelopmental Outcome in Early-Onset Neonatal Sepsis

Abstract

onatal sepsis is a clinical syndrome in an infant 28 days of life or younger manifested by systemic signs of infection and/or isolation of a bacterial pathogen from the blood stream. Early-onset neonatal sepsis is defined as the onset of symptoms within the first days of life; first 3 or first 7 days. Rapid diagnosis is problematic because the signs and symptoms of sepsis are subtle and nonspecific. In neonatology, currently, no single test fulfills the criteria of an ideal diagnostic test which can reliably diagnose sepsis in the newborn. Subtle neurological damage associated with sepsis is difficult to detect clinically, biochemical brain damage markers such as NSE would be of great value for diagnosis as they are objective, convenient and cheap. Also, transcranial Doppler studies may show impairment of cerebrovascular reactivity in patients with sepsis. Moreover, altered CBF may also be used as a surrogate marker for the diagnosis of early onset neonatal sepsis. Neuroinflammation during the perinatal period has a high risk of causing substantial long-term neurological morbidity.Survivors may have long-term cognitive impairment and lower health-related quality of life.Developmental tests such as the Griffith mental developmental scale have been recognised as valuable tools for assessing the development of infants and young children. It was noticed that neonatal biomarkers of inflammation in sepsis associated with a lower neurodevelopmental scores. This work was designed to assess the clinical utility of transcranial Doppler sonographic cerebral blood flow velocity measurements and serum neuron-specific enolase (NSE) determination in newly born infants for prediction of early-onset neonatal sepsis, evaluation of sepsis-induced cerebral injury, prognosis of the clinical outcome of sepsis and detection of the possible impact of sepsis on the infant’s neurodevelopment. This study included 100 neonates who were admitted to the NICUs of Ain Shams University Hospitals with clinical suspicion of sepsis from December 2013 till July 2015. Neonate with evidence of major congenital birth defects or chromosomal anomalies, delivery room resuscitation with the use of intubation and mechanical ventilation, evidence suggestive of perinatal asphyxia/hypoxic ischemic encephalopathy and hemodynamically significant cardiac abnormalities were excluded. The study included 53 males and 47 females with gestational age ranged between 30 a