EVALUATION OF POLYMORPHONUCLEAR LEUCOCYTE ELASTASE LEVEL AS AN EARLY DIAGNOSTIC INDICATOR IN NEONATAL SEPSIS.

Neonatal sepsis is a clinical syndrome of bacterial infection characterized by signs and symptoms of systemic involvement during the first month of life. Sepsis is the most common cause of neonatal mortality. Neonatal sepsis is an important but underestimated problem around the world. It is defined as disease affecting newborns ? 1 month of age with clinical symptoms and positive blood cultures. Infection is an important cause of morbidity and mortality during the neonatal period, despite the great improvements in intensive neonatal care and the use of extended spectrum antimicrobial agents. Polymorphonuclear (PMN) granulocytes play an important role as primary defence in the inflammatory reactions e.g sepsis and multiple organ dysfunction syndromes . They (PMN) use proteinases to digest the inflammatory mediators and tissue debris. One of these proteinases is PMN elastase. Neutrophil elastase is one of three hematopoietic serine proteases stored in large quantities in neutrophil cytoplasmic azurophilic granules. It acts in combination with reactive oxygen species to help degrade engulfed microorganisms inside phagolysosomes. These proteases are also externalized in an active form during neutrophil activation at inflammatory sites, thus contributing to the regulation of inflammatory and immune responses. Objective: is to determine the sensitivity and specificity of PMN elastase levels for the diagnosis of neonatal sepsis and its use as an early indicator of neonatal sepsis . Material and Methods: The study group consisted of forty patients with the diagnosis of sepsis ( 20 confirmed by +ve blood culture plus 20 clinically suspected and the control group included twenty newborn). Inclusion criteria were formerly sought in our subjects who were diagnosed using the Tollner scoring system and based on the clinical observations and laboratory findings. The results of white blood cell and platelet counts, immature/total neutrophil ratio, CRP and PMN elastase values were evaluated in the study groups. Enzyme linked immunoassay methods were used to determine the PMN elastase levels. Results: The mean PMN elastase level was found to be 1204±791.2 ng/mL in patients with comfirmed neonatal sepsis and 1231±750.05 ng/ml in clinically suspected cases (p<0.001) and 90.65 ± 33.65 ng/ml in control roup . When the plasma PMN elastase levels were compared between study groups, the specificity was %92, sensitivity was 96% negative estimation value was 90% and positive estimation value was 94%.