Effect of hydrocortisone therapy on the outcome of neonatal sepsis

Abstract

Neonatal sepsis is a clinical syndrome characterized by many signs and symptoms which are non specific for diagnosis. Blood culture is standard measure but needs time to give it's results. Hydrocortisone therapy in neonatal sepsis is still controversial for many years as clarified by many studies. The aim of the study is to evaluate the role of hydrocortisone therapy in decreasing the death rate from neonatal sepsis. The number of studied cases were 46 neonates diagnosed as a cases of neonatal sepsis after positive blood culture. Each one was assessed clinically by prepared questionnaire including history and clinical assessment. Laboratory parameters includes WBC count, ESR, were done before hydrocortisone therapy for all included cases. The included cases were divided into two groups ,one group were given hydrocortisone and the other group were treated without hydrocortisone . Eight babies were died during the first week of the therapy and 38 cases were followed up after 1wk.by the same parameters that mentioned above. Very early neonatal sepsis was the commonest clinical type of sepsis 30(65,2%) with poor feeding is the common presentation 40(87%).Group B. streptococcus was the commonest bacteria isolated in 17 cases (37%).Before the hydrocortisone therapy ESR, and WBC count were high in 26(56,5%)and 28(60,9%) respectively. After 1 week of hydrocortisone therapy WBC count was high in 4 cases (22,2%) in the group 1(with hydrocortisone therapy) as compared with ESR (0%), while in patients with group 2(without hydrocortisone therapy)the high ESR and WBC count was found in 2(10%)and(0) respectively. The total case fatality rate was (17,4%),while (21,7%) in patients with hydrocortisone therapy and(13%)in patients without hydrocortisone therapy.
Conclusion: There is a significant effect of hydrocortisone therapy on the white cell count, but it was observed that there was no effect of hydrocortisone therapy in decreasing the death rate from neonatal sepsis