Significance of neutrophilic CD64 as an early marker for detection of neonatal sepsis and prediction of disease outcome.

BACKGROUND: Neonatal sepsis (NS) is a global health problem owing to its significant contribution to morbidity and mortality. We evaluated the significance of neutrophilic CD64 (nCD64) expression as an early marker for diagnosis of NS compared to CRP and assessed its relation to disease outcome. METHODS: High sensitivity CRP (hs-CRP) and nCD64 were measured in 60 neonates with symptoms and signs of sepsis (40% were culture-proved) and 30 age- and sex-matched controls. RESULTS: Baseline hs-CRP and nCD64% were significantly higher among septic neonates compared with the controls (p < 0.05), while, no significant difference was found between the two septic groups (p > 0.05). nCD64 cutoff value > 34.1% was able to discriminate septic neonates from controls with higher sensitivity and specificity than hs-CRP. The mortality rate was 21.7% among septic neonates. Baseline nCD64% was significantly higher among died patients compared with recovered neonates (p = 0.009) while no significant difference was found between baseline hs-CRP and disease outcome (p = 0.117). CONCLUSION: Flow cytometric assessment of nCD64 was able to discriminate neonates with sepsis from controls with higher accuracy than hs-CRP; however, the combination of both nCD64% and hs-CRP enhances the ability to diagnose NS. Quantitative measurement of nCD64 can predict disease outcome in NS.

Post Discharge Formula Fortification of Maternal Human Milk of Very Low Birth Weight Preterm Infants: An Introduction of a Feeding Protocol in a University Hospital.

The objective of this study is to determine the growth parameters and nutritional biochemical markers and complications of fortification of human milk by post discharge formula of preterm very low birth weight newborns (VLBW). Fifty preterm infants less than 37 weeks with weight less than 1500 g were enrolled in the study. They received parental nutrition and feeding according to our protocol. When enteral feeding reached 100 cc/kg/day, infants were randomized into two groups: group I, Cases, n=25, where post discharge formula (PDF) was used for fortification, group II, Controls, n=25 with no fortification. Infants of both groups were given 50% of required enteral feeding as premature formula. This protocol was used until infants' weight reached 1800 g. Daily weight, weekly length and head circumference were recorded. Hemoglobin, albumin (Alb), electrolytes, blood urea nitrogen (BUN) and clinical complications were documented. Human milk fortification with PDF resulted in better growth with increase in weight 16.8 and 13.78 g/kg/day (P=0.0430), length 0.76 and 0.58 cm/week (P=0.0027), and head circumference of 0.59 and 0.5 cm/week (P=0.0217) in cases and controls respectively. Duration of hospital stay was less in cases (22.76 versus 28.52 days in Controls), P=0.02. No significant changes were found in serum electrolytes, BUN, or Alb between both groups. Hemoglobin was significantly higher in Cases, P=0.04. There were no significant clinical complications. Our feeding protocol of fortification of human milk with PDF in preterm very low birth weight newborns resulted in better growth and decrease in length of hospital stay. The use of PDF could be an alternative option for fortification of mothers' milk for preterm VLBW infants in developing countries with low resources.