Plasma nitric oxide and tumour necrosis factor-a and thrombomodulin levels in critically ill infants with neonatal sepsis

الملخص EN

To assess the contribution of the plasma concentrations of nitrate nitrite stable metabolites of nitric oxide (NO), tumour necrosis factor-a (TNF-a) , Thrombomodulin and C- reactive protein (CUP) to an early diagnosis of neonatal sepsis and to determine their possible values as predictors of outcome, our study was carried out on 35 full term neonates with septicemia (25 males and 10 females) and fifteen healthy full term neonates (nine males and six females) at controls.

All cases and control were subjected to thorough history taking, complete clinical examination, laboratory investigations including blood and or CSF cultures, arterial blood gases complete blood count, estimation of plasma levels TNF-a.

Stable metabolites of nitric oxide, thrombomodulin and CRP the initial samples were taken on day (at the time of sepsis evaluation) TNF-a was also analysed at the time when CRP was at its maximum level.

Chest and abdominal radiographs were routinely performed we compared our cases of neonatal sepsis through five groups Group I: Neonates with bacteriologically proven sepsis versus those with clinical sepsis, group II: case with gram + ve versus those with gram-ve septicemia.

Group III: Neonates with septic shock versus those without septic.

Shock, Group VI: Bleeder versus non bleeder cases Group V: Surviving versus non surviving cases.

Plasma concentrations of nitrate plus nitrite stable metabolites of nitric oxide, tumour necrosis factor-a.

thrombomodulin and immature/ totol neutrophil ratio>O.2 (I/T) were significantly increased in neonates with sepsis and septic shock compared with controls and septicemia newborns without septic, shock respectively.

Septicemia newborns with proven sepsis as well as non survivors and bleeders had higher levels of TNF- a, thrombomodulin and immature / total neutrophil ratio>0 2 compared with neonates with clinical sepsis survivors non bleeders respectively Maximal plasma concentrations of nitrate plus nitrite were correlated to the degree of hypotension (r= 0.63, p=0.02), and levels of TNF-a (r= 0.52.

p =0.05) respectively the optimal cut-off point was 12pg/ml for TNF-a and 13mg/Lfor CRF.

Initial CRP (CRP i) did not distinguish between controls and septic cases while initial TNF-a (TNF-a) did Initial TNF -a has higher sensitivity 90 % and negative predictive value (89 5%) far detecting sepsis on day 0 (at the time of sepsis evaluation).

CRP maximal value in controls differed markedly from that in the sepsis group (p<0.000l) while a contemporaneous TNF n taken at that time was of no diagnostic value.

Combining the TNF-a cut off value of >12pg/ml..AndCRP of >13mg/dL provides a sensitivity of98%.

Thus, neonates with neonatal sepsis showed increased levels of TNF-a, NO and CRP during the initial phase of their disease TNF-a is ahighly sensitive early alarm Cytokine and CRP Is a very specific late marker of infection.

CRP should therefore be used mainly in serial determinations or in combination with TNF-a to increase tls sensitivity and negative predictive value in diagnosis of neatal sepsis Further work will be required to determine if augmentation or inhibition of NO production in sepsis is of benefit since its Involvement, in sepsis is likely to be multifaceted.

TNF-a, NO level and thrombomodulin levels may actually correlate with the seriousness and prognosis of neonatal sepsis.

Vascular endothelial damage as indicated by rising plasma thrombcnnolulin car occur in septic neonates provided that renal and liver function tests are normal and this supports the clinical trials of using anti-thrombotic agents as adjutants to antibiotics in the.

Management of these disease Traditional neutrophil counts have at best, only suggestive value.