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Fecal calprotectin level increased significantly in neonates with feeding intolerance; it can be used to detect early cases with necrotizing enterocolitis in neonates, but this subject still needs more investigations on more patients.

Aim: Neonatal therapy-resistant septic shock is a common problem in middle and lowincome countries. We investigated whether newborn infants with infection and therapyresistant hypotension showed evidence of abnormal levels of cortisol or cortisol precursors. Methods:A total of 60 term or near term neonates with evidence of infection were enrolled after informed consent. Of these, 30 had an infection and refractory shock and 30 had an infection without shock. There were no detectable differences between the groups in the length of gestation, birth weight or gender distribution. Serum was obtained during days four and 14 after birth. Cortisol and cortisol precursor concentrations were analysed using liquid chromatography-tandem mass spectrometry. Results:The cortisol concentrations were low considering the expected responses to stress and they did not differ between the groups. The infants with infection and shock had higher serum dehydroepiandrosterone (DHEA) levels than those without shock (319.0±110.3 μg/dl, versus 22.3±18.3 μg/dl; p<0.0001) and they also had higher 17-hydroxy-pregnenolone, pregnenolone and progesterone concentrations. There were no detectable differences in the levels of 17-hydroxy-progesterone, 11-deoxy-cortisol, cortisol or cortisone. Conclusion:Septic newborn infants with therapy-resistant hypotension had very high DHEA levels, suggesting that 3-beta-hydroxysteroid dehydrogenase activity limited the rate of cortisol synthesis. Key notes• This study explored whether deficient endocrine stress responses in newborn infants influenced the risk of therapy-resistant shock during infection. Accepted ArticleThis article is protected by copyright. All rights reserved.• We found that when infections were complicated by shock, blood cortisol was within the normal range but cortisol precursors, particularly dehydroepiandrosterone, were much increased.• According to these findings there was limited cortisol synthesis in term infants affected by neonatal septic shock, supporting the rationale of corticosteroid therapy.

Salivary markers could serve as potential noninvasive markers in the diagnosis of neonatal infections. We aimed to investigate the diagnostic role of salivary and serum interleukin 10 (IL-10), C-reactive protein (CRP), mean platelet volume (MPV), and CRP/MPV ratio in the diagnosis of late-onset neonatal sepsis in full-term neonates. Seventy full-term neonates were enrolled in this prospective case-control study, 35 with late-onset neonatal sepsis, and 35 controls. Salivary IL-10, serum IL-10, and CRP concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Complete blood (CBC) count was measured by an automated blood cell counter. The salivary IL-10, serum IL-10, CRP, MPV, and CRP/MPV ratio levels were much higher in neonates with late-onset sepsis than in control ( 220 ± 150 vs. 18 ± 9   pg / ml , P < 0.001 ), ( 316 ± 198 vs. 23.7 ± 14   pg / ml , P < 0.001 ), ( 78.2 ± 34 vs. 3.3 ± 1.7   mg / L , P < 0.001 ), ( 11.2 ± 0.9 vs. 8.6 ± 0.4   fL ), and ( 7.08 ± 3.3 vs. 0.4 ± 0.2 , P < 0.001 ), respectively. At the cutoff point of >31 pg/ml, salivary IL-10 showed 97.1% sensitivity and 94.3% specificity. Serum IL-10 at a cutoff value of ≥33.6 pg/ml had a sensitivity of 97.1% and specificity of 80%. MPV showed a sensitivity of 100% and specificity of 94.4% at a cutoff   value ≥ 9.2   fL . CRP/MPV ratio showed a sensitivity of 100% and specificity of 97.1% at a cutoff   value > 0.9 . Salivary and serum IL-10 showed a positive correlation with CRP and CRP/MPV ratio in septic neonates. The current study shows for the first time that both salivary IL-10 and CRP/MPV showed statistically significant differences between neonates with late-onset sepsis and controls. Accordingly, salivary IL-10 could serve as a potential noninvasive biomarker for the diagnosis of late-onset sepsis in full-term neonates.

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In this study, we aimed to evaluate serum cystatin C (sCysC) as an early predictor of acute kidney injury (AKI) in preterm neonates with respiratory distress syndrome (RDS). Sixty preterm neonates diagnosed with RDS and 40 healthy controls (28-36 weeks) admitted to the neonatal Intensive Care Unit were investigated. AKI was defined on the 3rd day of life (DOL-3) as an increase in serum creatinine (sCr) of >0.3 mg/dL from baseline (the lowest previous sCr). sCysC levels were measured on DOL-1, -3 and -7. Of the 60 neonates with RDS, 24 (40%) developed AKI. Five patients (79.17%) were classified as AKI Network (AKIN-1) and 19 patients (20.83%), as AKIN-2. At DOL-3, the mean sCysC values were significantly higher among neonates with RDS and AKI (1.68 ± 0.37) compared with controls (0.79 ± 0.83) and those with RDS and no AKI (0.85 ± 0.20) (P <0.001). sCysC levels significantly increased among neonates with AKI from DOL-3 to DOL-7 (P = 0.002). The sCr values showed no significant difference between those with RDS with AKI, RDS, and no AKI or control groups at DOL-1 and -3. Only as late as DOL-7, the mean values of sCr were higher among neonates with AKI compared with no AKI and controls (P <0.001). The receiver operating characteristic curves area under the curve was 0.97 for predicting the development of AKI within 72 h (P = 0.001). With the best cutoff value of ≥1.28 mg/L, the sensitivity and specificity of sCysC for detecting AKI within 72 h were 100 and 83.3%, respectively. In conclusion, sCysC is an early marker for AKI in neonates with RDS.