This study will be conducted at the Neonatal intensive care Units at CHILDREN'S HOSPITAL, CAIRO UNIVERSITY and at ELGALAA Children's MILITARY HOSPITAL.~Population of study & disease condition:~Neonates with septicemia admitted to NICUs in CHILDREN'S HOSPITAL, CAIRO UNIVERSITY and in ELGALAA Children's MILITARY HOSPITAL.~Inclusion criteria:~Type of patient: Neonates with septicemia.~Age of patient: From 0-28 Days.~Sex: males and females.~Exclusion criteria:~Neonates with proved inborn error of metabolism.~Neonates with multiple congenital anomalies.~Neonates with severe birth asphyxia (APGAR score <4 at 5 minutes).~Methodology in details:~We will have 2 groups, each of them 50 neonates with septicemia. One group of premature neonates (32-36 weeks), the other group of full term neonates (>37 weeks).~All included Patients will be subjected to the following:~Full history with emphasis of relevant data as follows:~Date of birth, gestational age (AGA or SGA), gender, day of sepsis onset.~Clinical assessment:~Full systems examination.~Diagnosis of sepsis:~By abnormal Total leucocytic count or I/T ratio or CRP with clinical Suggestion (poor feeding, hepatomegaly, apnea, tachypnea, lethargy, …).~Confirm diagnosis by blood culture.~Sepsis will be considered severe if the neonate has sepsis plus one of the following: 1) cardiovascular organ dysfunction (hypotension or need for vasoactive drug) 2) 2 of the following (metabolic acidosis, increase lactic acid, oliguria, Prolonged capillary refill time) 3) Organ dysfunction (respiratory, renal, neurologic, hematologic).~SNAP II score:~For all neonates included in the study and its data collection within 24 hours from onset of sepsis, in the form of:~Lowest mean blood pressure.~Worst ratio of pao2/fio2~Lowest temperature.~Lowest serum PH.~Occurrence of multiple seizures.~Urine output<1 ml/kg/hour.~Follow up:~Follow up all neonates included in the study for 14 days: for morbidity and mortality.~Diagnosis of organ dysfunction:~Respiratory: by CXR and clinical examination. CVS: by blood pressure, capillary refill time, shock and need for inotropes. Renal: by urine output, kidney function tests. Hematology: by picture of DIC or pancytopenia. Neurology: by seizures, dilated fixed pupil.~Possible Risk:~None.~Primary outcomes:~Using Score for Neonatal Acute Physiology II as a Predictor of Mortality and Organ Dysfunction in Neonates with Septicemia.~Secondary outcomes:~Early anticipation of clinical manifestations of sepsis which will correlate most with poor outcome.~Sample size:~100 Neonates with septicemia admitted to NICUs in CHILDREN'S HOSPITAL, CAIRO UNIVERSITY and in ELGALAA Children's MILITARY HOSPITAL.
To determine the effect of Score for Neonatal Acute Physiology II as a Predictor of Mortality and Organ Dysfunction in Neonates with Septicemia in the Neonatal Intensive Care Units at CHILDREN'S HOSPITAL, CAIRO UNIVERSITY and at ELGALAA Children's MILITARY HOSPITAL.