EVALUATION OF SERUM AMYLOID A AS AN EARLY DIAGNOSIS OF SEPSIS IN NEONATES INFECTED WITH NOSOCOMIAL INFECTION

Abstract

Nosocomial sepsis is serious problem for neonates who are admitted for intensive care. As it is associated with increases in mortality, morbidity, and prolonged length of hospital stay, both the human and fiscal costs of these infections are high. As a result, antibiotic use is double the rate proven sepsis and we are facilitating the growth resistant organisms in the neonatal intensive care unit (Clark et al., 2004). Serum amyloid (SAA) is know best for its role during the acute phase response to an inflammatory stimulus such as infection, tissue injury, and trauma (Zhang, 2005). The present study was a case control prospective study was done on a group of neonates admitted into intensive care in the Neonatology unit Medicine. El-Galaa Teaching Hospital in Cairo. This study aimed to evaluate the diagnostic value of serum amyloid- A as an early diagnostic marker for neonatal sepsis, which is due to bacterial infection. The present study included 41 term neonates, 25 in the suspected group. All cases were subjected to the following: careful history taking including natal history; full clinical examination for early detection of manifestations of neonatal sepsis; and laboratory investigations. Three consecutive blood samples were collected from the suspected cases and one sample was taken from the control cases. The first sample (at birth, baseline) was taken when the sepsis was first suspected. The second and third samples were taken after 24 and 48 hours from the first sample. According to clinical symptoms of sepsis, microbiologic and laboratory results, neonates were classified into three groups: normal group (16 neonates), and the suspected group (25 neonates) which was subdivided into two subgroups according to clinical and biochemical evidence of infection and positive blood culture: (i) septic subgroup (17 neonates), which indicated that, there were 12 cases infected with gram negative organisms and they represent 70.6%, however there were 5 cases infected with gram positive organisms, which represent 29.4% and (ii) Non-septic subgroup (8 neonates). The latter are infants who were suspected of having sepsis initially, but with negative blood culture and no evidence of localized infection such as pneumonia or necrotizing enterocolitis (NEC).