SERUM NT-PRO BNP AND ITS ROLE IN THE DIAGNOSIS OF NEONATAL SEPSIS. A TERTIARY CARE HOSPITAL BASED STUDY

Abstract

The present study aimed to evaluate the effectiveness of NT-proBNP levels in diagnosing and prognosticating neonatal sepsis within a cohort of Kashmiri neonates.

The study was conducted over two years at the Department of Pediatrics and Neonatology at SKIMS Soura Srinagar, employing a hospital-based prospective design. A total of 100 neonates were included, equally divided into cases (suspected sepsis) and controls (healthy neonates). The primary objective was to assess whether NTproBNP, a biomarker traditionally used in diagnosing heart failure, could serve as a reliable marker for neonatal sepsis.The methodology involved selecting neonates with a Töllner sepsis score of 5 or higher, who were subsequently subjected to a range of diagnostic tests including NT-proBNP measurement, blood cultures, and routine biochemical assessments. The study meticulously excluded preterm neonates under 35 weeks of gestation, those with congenital heart diseases, and those who died within 72 hours of hospitalization. NT-proBNP levels were measured at the time of hospitalization and compared between the case and control groups.The results of this study highlighted significant disparities between neonates diagnosed with sepsis and the control group across various parameters. NT-proBNP levels were markedly elevated in the sepsis group, with 40% of the neonates exhibiting levels above 30,000 ng/L compared to just 4% in the control group. This substantial difference suggests a strong correlation between high NT-proBNP levels and the presence of neonatal sepsis, reinforcing the potential of NT-proBNP as a diagnostic biomarker.In terms of clinical presentation, neonates in the sepsis group showed a higher incidence of respiratory distress (60%), fever (40%), hypothermia (30%), and seizures (20%) compared to the control group. These symptoms were significantly more frequent in the sepsis group, indicating the severe systemic involvement typically seen in septic neonates. Additionally, the general examination revealed that neonates with sepsis had higher pulse rates and respiratory rates, along with lower systolic and diastolic blood pressures, which are indicative of cardiovascular stress and dysfunction.Laboratory findings further supported the clinical diagnosis of sepsis. The sepsis group demonstrated significantly lower total leukocyte counts, hemoglobin levels, and platelet counts, along with higher levels of urea, creatinine, and total bilirubin. These abnormalities are consistent with the systemic inflammatory response and multi-organ involvement characteristic of severe sepsis. The liver function tests indicated significant hepatic involvement, with elevated levels of ALT, ALP, and prolonged PT and INR, reflecting coagulopathy in septic neonates. Arterial blood gas analysis revealed acidosis, hypoxemia, and hypercapnia in the sepsis group, further indicating severe respiratory and metabolic derangements. Additionally, positive blood and cerebrospinal fluid cultures were found in 40% and 10% of the sepsis group, respectively, underscoring the bacterial etiology of sepsis in these neonates.