Role Of Plasma Fibrinogen In Diagnosis And Prediction Of Short Term Outcome Of Neonatal Seps

Abstract

Neonatal septicemia is characterized by systemic response to bacterial infection documented by positive blood culture in first 4 weeks of life. Neonatal septicemia is one of the leading cause of neonatal mortality and morbidity1,2,3. It is a clinical syndrome characterized by signs and symptoms of infection with or without bacteremia in the first month of life. Early diagnosis of neonatal sepsis is difficult clinically as various other disorders affecting newborn mimic it. Blood culture is considered to be the gold standard diagnostic modality for neonatal sepsis, but the culture reports would be available only after 48-72 hours.3,4 Since early detection and treatment can reduce morbidity and mortality, there is a need for markers of sepsis like hematological parameters and acute phase reactants. Plasma fibrinogen is one such acute phase reactant. Fibrinogen also known as factor I of coagulation pathway, is produced in liver as a high molecular weight glycoprotein and plays an important role in haemostasis as a coagulation factor2. Thrombin splits off fibrinopeptides A and B from fibrinogen to form fibrin monomers which polymerize subsequently. Fibrin is stabilized to form a dense aggregate by covalent cross-linkage catalyzed by activated factor VIII2. Decrease in fibrinogen level is observed in disseminated intravascular coagulation (DIC) where it is consumed in the coagulation process. Fibrinogen levels are increased in inflammation where it acts as positive acute phase reactant To study the relation between plasma level of fibrinogen and neonatal sepsis and its outcome. iv MATERIALS AND METHODS: A prospective case control hospital based study was carried out on neonates fulfilling the inclusion and exclusion criteria admitted in NICU, department of Pediatrics, referred to the Department of Pathology in BLDE (Deemed to be University) Shri B.M. Patil Medical College Hospital & Research Center, Vijayapura. Study period: 1st December 2017 to 30th June 2019. Blood samples were collected in Citrated, plain and EDTA anticoagulated vacutainers for Plasma fibrinogen, blood culture and analysis of hematologic parameters respectively. RESULTS: 48 suspected cases of neonatal sepsis and 42 cases of neonatal jaundice were included in study group and control group respectively. Plasma fibrinogen levels were found to be significantly elevated in study group than in control group (p< 0.050). It had sensitivity and specificity of 80% and 72.8% respectively for diagnosis of neonatal sepsis at cut off value of 305.5 mg/l. CONCLUSION: In our study, we found that plasma fibrinogen act as an acute phase reactant and can be used as an immediate marker for detection of early onset neonatal sepsis. Plasma fibrinogen is a simple, rapid and cost effective test. It could guide the clinicians in instituting early treatment and adopting aggressive treatment whenever applicable, thus reducing the neonatal morbidity and mortality.