BACKGROUND Neonatal sepsis is a life-threatening disease.Early diagnosis is essential,but no single marker of infection has been identified.Sepsis activates a coagulation cascade with simultaneous production of the D-...BACKGROUND Neonatal sepsis is a life-threatening disease.Early diagnosis is essential,but no single marker of infection has been identified.Sepsis activates a coagulation cascade with simultaneous production of the D-dimers due to lysis of fibrin.Ddimer test reflects the activation of the coagulation system.AIM To assess the D-dimer plasma level,elaborating its clinicopathological value in neonates with early-onset and late-onset neonatal sepsis.METHODS The study was a prospective cross-sectional study that included ninety neonates;divided into three groups:Group I:Early-onset sepsis(EOS);Group II:Late-onset sepsis(LOS);and GroupⅢ:Control group.We diagnosed neonatal sepsis according to our protocol.C-reactive protein(CRP)and D-dimer assays were compared between EOS and LOS and correlated to the causative microbiological agents.RESULTS D-dimer was significantly higher in septic groups with a considerably higher number of cases with positive D-dimer.Neonates with LOS had substantially higher levels of D-dimer than EOS,with no significant differences in CRP.Neonates with LOS had a significantly longer hospitalization duration and higher gram-negative bacteriemia and mortality rates than EOS(P<0.01).Gramnegative bacteria have the highest D-dimer levels(Acinetobacter,Klebsiella,and Pseudomonas)and CRP(Serratia,Klebsiella,and Pseudomonas);while gram-positive sepsis was associated with relatively lower levels.D-dimer had a significant negative correlation with hemoglobin level and platelet count;and a significant positive correlation with CRP,hospitalization duration,and mortality rates.The best-suggested cut-off point for D-dimer in neonatal sepsis was 0.75 mg/L,giving a sensitivity of 72.7%and specificity of 86.7%.The D-dimer assay has specificity and sensitivity comparable to CRP in the current study.CONCLUSION The current study revealed a significant diagnostic value for D-dimer in neonatal sepsis.D-dimer can be used as an adjunct to other sepsis markers to increase the sensitivity and specificity of diagnosing neonatal sepsis.展开更多
Sepsis remains a significant cause of neonatal morbidity and mortality in China.A better understanding of neonatal sepsis in China as compared with other industrialized and non-industrialized countries may help optimi...Sepsis remains a significant cause of neonatal morbidity and mortality in China.A better understanding of neonatal sepsis in China as compared with other industrialized and non-industrialized countries may help optimize neonatal health care both regionally and globally.Literature cited in this review was retrieved from PubMed using the keywords"neonatal sepsis,""early-onset(EOS)"and"late-onset(LOS)"in English,with the focus set on population-based studies.This review provides an updated summary regarding the epidemiology,pathogen profile,infectious work-up,and empirical treatment of neonatal sepsis within and beyond China.The incidence of neonatal EOS and the proportion of Group B Streptococcus(GBS)within pathogens causing EOS in China seem to differ from those in developed countries,possibly due to different population characteristics and intrapartum/postnatal health care strategies.Whether to adopt GBS screening and intrapartum antibiotic prophylaxis in China remains highly debatable.The pathogen profile of LOS in China was shown to be similar to other countries.However,viruses as potential pathogens of neonatal LOS have been underappreciated.Growing antimicrobial resistance in China reflects limitations in adapting antibiotic regimen to local microbial profile and timely cessation of treatment in non-proven bacterial infections.This review stresses that the local epidemiology of neonatal sepsis should be closely monitored in each institution.A prompt and adequate infectious work-up is critically important in diagnosing neonatal sepsis.Adequate and appropriate antibiotic strategies must be overemphasized to prevent the emergence of multi-resistant bacteria in China.展开更多
文摘BACKGROUND Neonatal sepsis is a life-threatening disease.Early diagnosis is essential,but no single marker of infection has been identified.Sepsis activates a coagulation cascade with simultaneous production of the D-dimers due to lysis of fibrin.Ddimer test reflects the activation of the coagulation system.AIM To assess the D-dimer plasma level,elaborating its clinicopathological value in neonates with early-onset and late-onset neonatal sepsis.METHODS The study was a prospective cross-sectional study that included ninety neonates;divided into three groups:Group I:Early-onset sepsis(EOS);Group II:Late-onset sepsis(LOS);and GroupⅢ:Control group.We diagnosed neonatal sepsis according to our protocol.C-reactive protein(CRP)and D-dimer assays were compared between EOS and LOS and correlated to the causative microbiological agents.RESULTS D-dimer was significantly higher in septic groups with a considerably higher number of cases with positive D-dimer.Neonates with LOS had substantially higher levels of D-dimer than EOS,with no significant differences in CRP.Neonates with LOS had a significantly longer hospitalization duration and higher gram-negative bacteriemia and mortality rates than EOS(P<0.01).Gramnegative bacteria have the highest D-dimer levels(Acinetobacter,Klebsiella,and Pseudomonas)and CRP(Serratia,Klebsiella,and Pseudomonas);while gram-positive sepsis was associated with relatively lower levels.D-dimer had a significant negative correlation with hemoglobin level and platelet count;and a significant positive correlation with CRP,hospitalization duration,and mortality rates.The best-suggested cut-off point for D-dimer in neonatal sepsis was 0.75 mg/L,giving a sensitivity of 72.7%and specificity of 86.7%.The D-dimer assay has specificity and sensitivity comparable to CRP in the current study.CONCLUSION The current study revealed a significant diagnostic value for D-dimer in neonatal sepsis.D-dimer can be used as an adjunct to other sepsis markers to increase the sensitivity and specificity of diagnosing neonatal sepsis.
文摘Sepsis remains a significant cause of neonatal morbidity and mortality in China.A better understanding of neonatal sepsis in China as compared with other industrialized and non-industrialized countries may help optimize neonatal health care both regionally and globally.Literature cited in this review was retrieved from PubMed using the keywords"neonatal sepsis,""early-onset(EOS)"and"late-onset(LOS)"in English,with the focus set on population-based studies.This review provides an updated summary regarding the epidemiology,pathogen profile,infectious work-up,and empirical treatment of neonatal sepsis within and beyond China.The incidence of neonatal EOS and the proportion of Group B Streptococcus(GBS)within pathogens causing EOS in China seem to differ from those in developed countries,possibly due to different population characteristics and intrapartum/postnatal health care strategies.Whether to adopt GBS screening and intrapartum antibiotic prophylaxis in China remains highly debatable.The pathogen profile of LOS in China was shown to be similar to other countries.However,viruses as potential pathogens of neonatal LOS have been underappreciated.Growing antimicrobial resistance in China reflects limitations in adapting antibiotic regimen to local microbial profile and timely cessation of treatment in non-proven bacterial infections.This review stresses that the local epidemiology of neonatal sepsis should be closely monitored in each institution.A prompt and adequate infectious work-up is critically important in diagnosing neonatal sepsis.Adequate and appropriate antibiotic strategies must be overemphasized to prevent the emergence of multi-resistant bacteria in China.
