Background: Late onset sepsis (LOS) is an important cause of serious illness and deaths among neonates. Diagnosis of neonatal sepsis remains a challenge owing to nonspecific early clinical signs and the non-availability of a reliable biomarker. Serum amyloid A (SAA), the precursor protein in inflammation-associated reactive amyloidosis, whose level in the blood increases up to 1000 fold in response to inflammation and it is also an acute phase reactant like PCT and CRP. Objectives: assessing the accuracy and rapidity of SAA in detection of LOS in neonates. Method: This is a case-control study which was carried out on neonates admitted in (NICU) of Benha University Hospital and Benha Teaching Hospital during the period (from June 2018 to November 2019). Group 1 (patients group): 45 neonates with neonatal sepsis, group 2 (control group): 40 healthy neonates age and sex matched. SAA was measured. Results:mean value of SAA in septic group was 38.8 µg/ml compared to 1.26 µg/ml in control group , with statistically significant increase in patients than controls (p<0.001). ROC curve was done to show the performance of SAA in the prediction of LOS. It was found that at a cut-off value of SAA >2.8 µg/ml, SAA had a sensitivity 86.7%, specificity 85%, PPV 86.7%, and NPV 85% for early diagnosis of LOS. At a cut-off value of SAA>45.2 µg/ml, SAA had a sensitivity 83.3%, specificity 69.7%, PPV 50%, and NPV 92% for the prediction of mortality among LOS patients. Conclusion: The high sensitivity, specificity, positive predictive value and negative predictive value of SAA protein could help the clinicians for early diagnosis of LOS.

Background: High-mobility group box 1 (HMGB1) has important role in a variety of diseases, including neonatal sepsis (NS). The aim of this study is to evaluate the clinical importance of HMGB1 genetic expression in NS demonstrating its diagnostic value and detecting the effect of its genetic expression on the disease outcome. Patients and Method: This study was carried out on 100 neonates; 28 neonates with clinical sepsis and had positive blood cultures (confirmed), 22 neonates with clinical sepsis but had negative blood cultures (suspected) and 50 healthy non-infected newborns age and sex matched as controls.Results: Expression of HMGB1 in newborns with confirmed NS and those with suspected NS were higher than healthy controls. Also, it was higher in newborns with confirmed NS than those with suspected NS. The sensitivity and specificity of the diagnostic value of HGMB1 were higher than that of C-reactive protein (CRP) and hematological score (H score). Assessment of the HMGB1 for prognosis of the disease was evaluated by univariate analysis (p=<0.002) and logistic multivariate regression analysis (p=<0.023). The univariate analysis showed that CRP, H score and HMGB1 are significantly predicting the prognosis of NS, while the multivariate analysis showed that only HMGB1 significantly predict the prognosis of NS. There were significant positive correlations between HMGB1 gene expression and APGAR score at 5 minutes, hemoglobin level, H. score and CRP titer in confirmed N Conclusion: HMGB1 is a possible diagnostic and prognostic marker of neonatal sepsis (NS).

Background: Mortality in outborns with Neonatal sepsis result from interaction of maternal-fetal colonization, transplacental immunity and physical and cellular defense mechanisms of neonates. Objective: The objective of this study was to determine risk factors 0f mortality in outborn with neonatal sepsis. Materials and Methods: A 6-months prospective observational study was done at neonatal intensive care unit of Benha university hospital and Serselyan General Hospital. All outborn neonates with maternal and neonatal risk factors of sepsis were enrolled. Blood culture, sepsis screen and other needed investigations were performed. Results: The mortality rate among outborn with neonatal sepsis was 42%.The common presentations among outborns with neonatal sepsis were Hypothermia, convulsions, cyanosis and poor suckling. The ,significant risk factors of mortality include Malesex (p=0.021), gestational age (p=0.027), presence of convulsions(p=0.003), cyanosis(p=0.02), hypothermia(p=0.009), mottling(p=0.001),poor suckling(p=0.001),positive c-reactive protein(p=0.009), Anemia(p=0.011)..Maternal factors such as Premature rupture of membranes (p=0.047)and hypertension during pregnancy (p=0.001) and diabetes mellitus (p=0.017) were statistically significant associated with mortality in outborn neonatal sepsis. On multivariate logistic regression temperature on admission and distance during transport to hospital were the predictive factors of mortality in outborn neonatal sepsis. Conclusion:Long distance tranelled with neonates during transport to hospital and presentation with hypothermia at admission, were the independent risk factors of mortality in outborn neonatal sepsis.

Background: Maternal iron condition influences the iron status of neonates since iron transferred from the mother is the only source for fetal iron. The aim of this study was to examine the association of obesity with inflammatory markers (CRP) and iron status in both mother and infant. Methods: This comparative cross sectional study was conducted on 100 pregnant women and their neonate from the attendance of Agouza Police Hospital and Benha University Hospitals. Results: Our results shows that there was no statistically significant difference found between obese and non-obese pregnant women regarding neonatal HB, TLC, Platelets count, Serum iron in cord, TIBC in cord and CRP in cord. There was a negative impact of maternal BMI on neonatal iron status. The maternal obesity was inversely associated with cord ferritin concentrations, poorer iron status determined by cord ferritin were evident in the neonates of obese women, compared with those born to normal weight women. Maternal CRP, maternal hepcidin and maternal serum transferrin receptor were greater in obese compared with normal weight pregnant women. Conclusion: There is a negative impact of maternal BMI on neonatal iron status. The maternal obesity was inversely associated with cord ferritin concentrations, poorer iron status determined by cord ferritin were evident in the neonates of obese women, compared with those born to normal weight women. The concentrations of CRP was greater in obese compared with normal weight pregnant women. Serum hepcidin was elevated in obese pregnant women compared with the normal weight women in this study.

Objectives: to investigate the clinical, neuroimaging, and electroencephalographic characteristics of pediatric medically intractable epilepsy in order to predict and overcome this intractability. Methods: We conducted a prospective case-control study with 50 participants, divided into a study group of 25 patients with refractory epilepsy and a control group of 25 epileptic children with good control of seizures. All participants underwent a comprehensive assessment, including medical history, physical examination, neuroimaging, neurophysiological evaluation, and metabolic workup. Results:The study revealed that total number of patients was 50 (25 case 12 male & 13 female and 25 control 11 male & 14 female). Children with refractory epilepsy had abnormal neuroimaging. Additionally, the interictal EEG monitoring showed more frequent epileptiform discharges in the refractory group. Conclusions: It is important to evaluate pediatric patients with medically intractable epilepsy. Abnormal development, neuroimaging and frequent epileptiform discharges on EEG may indicate a higher likelihood of refractory epilepsy for further research with large number.