2018, Vol. 1, Issue 2, Part A

Background and Objective: Sepsis, defined as a “life-threatening organ dysfunction caused by a dysregulated host-response to infection” is a major health issue worldwide and still lacks a fully elucidated pathobiology and uniform diagnostic tests. The trace element zinc is known to be crucial to ensure an appropriate immune response. During sepsis a redistribution of zinc from serum into the liver has been observed and several studies imply a correlation between zinc and sepsis outcome. Therefore the alterations of zinc concentrations in different tissues might serve as one part of the host’s defense mechanism against pathogens during sepsis by diverse mechanisms. It has been suggested that zinc is involved in nutritional immunity, acts as a hepatoprotective agent, or a differentiation signal for innate immune cells, or supports the synthesis of acute phase proteins. Limited studies are available on zinc in neonatal sepsis and also zinc deficiency as a predisposing factor of neonatal sepsis. This prompted us to assess zinc levels in neonatal sepsis and its outcome. The primary outcome was treatment failure which was a need to change antimicrobial treatment, or death at any time. Secondary outcome was time to clinical recovery. Moreover, the changes in zinc homeostasis are substantial and correlate with the severity of the disease, suggesting that zinc might also be useful as a diagnostic marker for evaluating the severity and predicting the outcome of sepsis.

Methods: A cross sectional prospective study was undertaken at SIMS, Hyderabad during. January 2016 TO June 2017. A total of 50 neonates with clinical suspicion of sepsis were included in our study. Maternal clinical history, risk factors and detailed history of neonate was taken followed by a detailed general and systemic examination. Sepsis screen and Serum Zinc levels were obtained. Based on Sepsis Score, the neonates were categorized as Possible, Probable and High Probable Sepsis. Serum Zinc levels were correlated with Onset of Sepsis, Sepsis Score, CRP levels, upgradation of antibiotics and duration of hospital stay.

Results: We had enrolled 50 newborns as per our inclusion criteria. Among the 50 neonates in the study, we had 42 (80%) inborns and 10 (20%) were outborns. Majority of the neonates were term newborn 45(90%) and 5 (10%) were preterm. Of the 50 neonates in our study, majority were term (45, 90%) and 5 (10%) were preterm. Mean gestational age was 39.2 ± 3.2 weeks. Mean birth weight was 2.85 ± 0.517 kg. In our study, we found that majority (70%) of neonates admitted to NICU with suspicion of neonatal sepsis had fever. 30% neonates presented with respiratory distressed birth and 87% with perinatal depression. Majority of our subjects had Probable Sepsis (50%). Possible Sepsis and High Probable Sepsis were seen in 40% and 10% of the neonates respectively. The overall mean Serum Zinc level was 66.0  20.50 g/dl. More than half of the neonates enrolled in our study had low Serum Zinc levels (N= 28, 56%). The mean level of serum zinc of the zinc deficient group was 44.12  7.2 g/dl. The mean Serum Zinc level in neonates with early onset sepsis was 65  23.14 g/dl and late onset sepsis was 68.20  22.11 g/dl. The mean Serum Zinc levels of neonates with Possible, Probable and High Probable Sepsis was 83.2  22.22 g/dl, 54.0  14.33 g/dl 55.02 17.66 g/dl respectively

Conclusion: Changes in zinc homeostasis are substantial and correlate with the severity of the disease, suggesting that zinc could be used as a diagnostic marker for evaluating the severity and predicting the outcome of sepsis or even as a starting point for therapeutic approach.