Abstract
Background and Objectives
Sepsis leads to systemic inflammatory response with cerebral blood flow (CBF) alteration and blood–brain barrier disruption that contribute to sepsis-associated encephalopathy (SAE). We aimed to evaluate cord blood neuron-specific enolase (cNSE) and CBF in early-onset neonatal sepsis (EONS) as predictors of SAE and to define short-term neurodevelopmental outcomes among survivors.
Methods
cNSE was measured in 200 neonates with antenatal risk factors for EONS, stratified into two groups: sepsis (n = 96) and no-sepsis (n = 104). Trans-cranial Doppler of peak systolic velocities (PSV), end diastolic velocities (EDV) and resistive indices (RI) of anterior (ACA) and middle (MCA) cerebral arteries recorded on day 1 postnatal. Griffiths mental developmental scale (GMDS) was assessed at 6 months.
Results
Increased cNSE, PSV, EDV, and decreased RI of both ACA and MCA were found in sepsis group compared to no-sepsis group (p < 0.001 for all). Patients with SAE (n = 34) had higher NSE, PSV, and EDV as well as lower RI of ACA and MCA compared to those without (p < 0.01 for all). SAE neonates had lower GMDS than those without. ACA RI of ≤0.61 was the best predictor of SAE.
Conclusion
High CBF and cNSE could be useful markers for prediction of SAE. SAE impairs neurodevelopmental scales at 6 months.
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M.S.E.S. and R.A.E.F. conceptualized and designed the study. N.M.E.R. and H.A.S. contributed to the conceptualization and drafted the initial manuscript. H.E.M. and D.H.S. contributed to the study design and performed Doppler ultrasonography. M.A.A.S. and N.M.B. supervised data collection, laboratory investigations, and analyzed and interpreted the data. A.S.F. contributed to the study design, selection of obstetric patients and diagnosis of maternal chorioamnionitis, and analyzed and interpreted the data. A.K.E.Z. contributed to the conceptualization, performed Griffiths mental developmental scale, and neurological examination at 6 months of age. All authors contributed to data interpretation and manuscript writing and have read and approved the final submission.
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El Shimy, M.S., El-Raggal, N.M., El-Farrash, R.A. et al. Cerebral blood flow and serum neuron-specific enolase in early-onset neonatal sepsis. Pediatr Res 84, 261–266 (2018). https://doi.org/10.1038/s41390-018-0062-4
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DOI: https://doi.org/10.1038/s41390-018-0062-4
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