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ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 2  |  Page : 474-477

Study on nitric oxide level in septicemic neonates


Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission09-Jun-2013
Date of Acceptance19-Jan-2014
Date of Web Publication26-Sep-2014

Correspondence Address:
Samar Moustafa El Hak
MBBCh, Al Menshawy General Hospital, Al Amrya Al Mahalla Al Kubra Al Gharbya Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.141731

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  Abstract 

Objectives
The aim of this work was to study on the clinical importance of nitric oxide (NO) level in neonatal septicemia.
Background
Diagnosis of neonatal septicemia is very important. This study was conducted to evaluate the role of NO in the diagnosis of neonatal septicemia in the neonatal ICU of Menoufia University.
Patients and methods
This study was conducted on 50 neonates (30 septic and 20 healthy neonates). All neonates were subjected to detailed history taking, through clinical examinations, and laboratory investigations (complete blood count, C-reactive protein, blood culture, and serum NO level).
Results
The serum level of NO was increased in all studied septic neonates, in comparison with the control group. The elevation in the NO level is independent of gestational age, and there was no significant relation between the NO level and neonatal body weight. The elevation in the NO level is independent of the onset of sepsis, with a cutoff value of 43.7 ΅mol/l.
Conclusion
Serum levels of NO were elevated in newborn infants with sepsis. Serum NO can be added to the sepsis screen for the early prediction of neonatal sepsis.

Keywords: Neonatal septicemia, nitric oxide, sepsis in neonatal ICU


How to cite this article:
Mahmoud AT, Tawfik MM, Alshafey MK, El Hak SM. Study on nitric oxide level in septicemic neonates. Menoufia Med J 2014;27:474-7

How to cite this URL:
Mahmoud AT, Tawfik MM, Alshafey MK, El Hak SM. Study on nitric oxide level in septicemic neonates. Menoufia Med J [serial online] 2014 [cited 2020 Feb 24];27:474-7. Available from: http://www.mmj.eg.net/text.asp?2014/27/2/474/141731


  Introduction Top


Neonatal sepsis is a disease in infants who are younger than 1 month of age, clinically ill, and have positive blood cultures. The presence of clinical manifestations distinguishes this condition from the transient bacteremia observed in some healthy newborns [1].

In Egypt, neonatal sepsis is considered a big problem with lack of infection control measures, exposure to adult infection, and inadequate nursing staff, and the incidence range increases more than the documented incidence. There is a need for early diagnosis of neonatal sepsis to start intervention as early as possible [2].

These vulnerable patients are presented to the emergency department with nonspecific symptoms and are unable to articulate their concerns. Bacterial infections are an important cause of morbidity and death among neonates, especially those born before term; mortality from neonatal sepsis remains around 20% [3].

There are three main reasons for this:

  1. Deficient host defense mechanisms in the newborn, particularly when preterm;
  2. Lack of a specific and sensitive test to diagnose sepsis early; and
  3. Little use of host defense-modulating therapies in neonatal sepsis [4].


Neonatal sepsis is either classified as early or late based on the timing of presentation, the onset of sepsis within the first 48 h of life (early-onset sepsis) is frequently associated with prenatal and perinatal predisposing factors, whereas onset after 48-72 h of life (late-onset sepsis) frequently reflects infection acquired nosocomially [5].


  Aim of the work Top


The aim of this study was to evaluate the clinical importance of serum nitric oxide (NO) level in neonatal septicemia.


  Patients and methods Top


This study was carried out in the neonatal ICU of the Department of Pediatrics of Menoufia University Hospital during a period of 10 months from June 2012 to March 2013.

It was conducted on 50 septic neonates, according to clinical and hematological sepsis score, divided into two groups.

  1. Group A: It included 30 neonates classified according to their gestational age.
  2. Group A1: Fifteen full-term (10 male and five female) neonates, their birth weight ranged from 2300 to 3400 kg and their age ranged from 2 to 30 days.
  3. Group A2: Fifteen preterm (nine male and six female) neonates, their weight ranged from 1500 to 1850 kg and their age from 2 to 20 days.
  4. Group B: Twenty healthy neonates (11 male and nine female), their weight ranged from 1550 to 3300 kg and their age from 1 to 29 days.


Inclusion criteria

All neonates were admitted to the neonatal ICU with sepsis according to clinical and hematological sepsis scoring system.

Exclusion criteria

  1. Neonates with renal disease.
  2. Neonates with major congenital anomalies.
  3. Neonates with inborn error of metabolism.
  4. Neonatal asphyxia.
  5. Neonates with surgical problems.


All neonates included in the study were subjected to the following:

  1. History taking.
  2. Clinical examination.
  3. Laboratory investigations
    1. Complete blood count.
    2. C-reactive protein.
    3. Serum level of NO.



  Results Top


Serum level of NO was increased in all studied septic groups, in comparison with control groups.

The cutoff value of NO recorded in this study was 43.7 μmol/l, with sensitivity 94.7%, specificity 92.2%, and positive predictive value 90.7% in the studied septic groups.

Blood culture showed that Klebsiella spp. was the most common causative organism in the full-term group; however,  Escherichia More Details coli in the preterm group was the most common organism.

The elevation in the NO level was independent of gestational age. There was no significant difference in the serum levels of NO between septic preterm and septic full-term neonates. There was no significant relation between NO level and neonatal body weight. The elevation in the NO level was independent of the onset of sepsis.


  Discussion Top


Neonatal septicemia is a major cause of mortality and morbidity worldwide. Early detection of sepsis in neonates is one of the most difficult problems faced by neonatal care providers and clinicians today. The definitive diagnosis of septicemia is made by a positive blood culture, which usually requires 48-72 h and yields a positive result in only 30-70% of cases [6].

In this study, there was an elevated level of NO in all studied septic groups, in comparison with the control groups. These results were in agreement with Shi et al. [7], who concluded that the circulatory nitrite (NO 2 ) and nitrate (NO 3 ) levels (the sum of them has been confirmed to be a good indicator of NO production) are elevated in newborn infants with sepsis.

These results were in agreement with Wong et al. [8], who studied the total serum nitrite and nitrate concentrations in children with sepsis syndrome, and demonstrated that increased serum concentrations of nitrite and nitrate are indicative of endogenous overproduction of NO in children with sepsis syndrome.

Our findings were also in agreement with Doughty et al. [9], who studied children meeting the criteria for sepsis, not receiving endogenous sources of NO, and they concluded that plasma nitrite and nitrate concentrations are increased in children who developed sepsis-induced multiple organ failure.

These findings were in agreement with El-Sallab et al. [10], who reported the elevation in the NO level of the plasma of septic neonates and concluded that the plasma levels of NO can be added to sepsis screen for prediction of neonatal sepsis [Figure 1].
Figure 1:

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The cutoff value of NO recorded in this study was 43.7 μmol/l, with sensitivity 94.7%, specificity 92.2%, and positive predictive value 90.7% in the studied septic group, as shown in [Figure 2].
Figure 2:

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These findings were comparable to De Werra and colleagues, where the cutoff value of NO was 57 μmol/l and positive predictive value was 96% [Figure 3].
Figure 3:

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In the plasma level of nitrite and nitrate in septic neonates, the cutoff value ranged from 10.1 to 60.4 μmol/l, with median level of 35.2 μmol/l, whereas the level of NO was more than 41.7 μmol/l [11] [Table 1],[Table 2],[Table 3],[Table 4],[Table 5] and [Table 6].
Table 1: Comparison between levels of nitric oxide in septic and control groups

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Table 2: Discriptive statistics of blood culture results among patients groups

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Table 3: Effect of gestational age on nitric oxide level

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Table 4: Affection of nitric oxide levels by weight of patients

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Table 5: Relation between the nitric oxide level and onset of sepsis

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Table 6: Comparison of nitric oxide level and blood culture results of septic patients

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  Conclusion Top


NO played some important roles in the pathophysiology of neonatal sepsis. Serum NO levels were elevated in newborn infants with sepsis. Therefore, it can be added to the sepsis screen for early diagnosis of neonatal sepsis.

The elevation in the NO level was independent of gestational age, whether the neonate was preterm or full term. There was no significant relation between the NO level and neonatal body weight. In addition, the elevation in the NO level was independent of the onset of sepsis, whether it was early or late onset.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.Tausch WH, Ballard RA, Gleason CA. Avery′s diseases of the newborn. 8th ed. Philadelphia: WB Saunders; 2005. 4 :52-58.  Back to cited text no. 1
    
2. Youssry I, Edris A, Tawfik N, Rizk S, Elew H, Mokhtar D, Elmessery L. Monocytes expressing tissue factor as a diagnostic marker of neonatal sepsis. Pediatrics 2008; 816 :121-124.  Back to cited text no. 2
    
3. Mclntire D, Bloom S, Casey B, Leaven K. Birth weight in relation to morbidity and mortality among newborn infants. Engl J Med 2003; 35:1234-1238.  Back to cited text no. 3
    
4. Mclntosh N. The newborn In: Campbell AG, Mclntosh N, editors. Forfar and Arneils textbook of pediatrics. 10th ed. Churchil Livingstone; 2002. 312-318.  Back to cited text no. 4
    
5. Afroza S. Neonatal sepsis a global problem: an overview. Mymensingh Med J 2006; 15 :108-114.  Back to cited text no. 5
    
6. Manucha V, Rusia Y, Sikka M, Madan N. Utility of hematological parameter and C-reactive protein in detection of neonatal sepsis. 2002; 178-192.  Back to cited text no. 6
    
7. Shi Y, Li HG, Shen CK. Plasma nitric oxide levels in newborn infants with sepsis. J Pediatr 1993; 123 :435-438.  Back to cited text no. 7
    
8. Wong HR, Carcillo JA, Burckart GB. Increased serum nitrite and nitrate concentrations in children with sepsis syndrome. Crit Care Med 1995; 23 :835-842.  Back to cited text no. 8
    
9. Doughty L, Carcillo JA, Kaplan S. Plasma nitrite and nitrate concentrations and multiple organ failure in pediatric sepsis. Intensive Care Med 2003; 29 :9840-9844.  Back to cited text no. 9
    
10.El-Sallab S, Abu Hashem EM, Abdel Hady HE. Plasma nitric oxide and carbon monoxide levels in neonatal sepsis. The Third Annual Conference of The Egyptian Association of Neonatology; 14-15 February 2002.  Back to cited text no. 10
    
11.De Werra I, Jaccard C, Corradin SB. Cytokines, nitrite/nitrate, soluble tumour necrosis factor receptors, and procalcitonin concentrations: comparison in patients with septic shock, cardiogenic shock, and bacterial pneumonia. Crit Care Med 1997; 25 :607-613.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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  In this article
Abstract
Introduction
Aim of the work
Patients and methods
Results
Discussion
Conclusion
Acknowledgements
References
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