A study of Protein C level and Activated Partial Thromboplastin Time among neonates suffering of sepsis-Omdurman Maternity Hospital, Sudan.

Objectives: The study aimed to assess Activated Partial Thromboplastin Time (APTT) and Protein C (PC) among Sudanese neonates with sepsis (Cases) in Omdurman maternity hospital, Sudan compared with healthy neonates (controls) for recognizing haemostatic alteration in APTT and PC, considering the gender, gestational age, delivery mode among both groups, case group categorized additionally regarding; sepsis onset, outcome, and Gram stain typing of the causative agent. Results: A total of 100 neonates divided equally into septic cases and healthy controls, died neonates were constituted 10 (20%) while 40 (80%) were recovered among case group. APTT showed significant prolongation in septic neonates compared to controls (mean; 47.8 and 37.5 sec for cases and controls, respectively) P. value was 0.00. Among case group; dead neonates showed significant prolongation compared recovered (mean; 61.5 and 44.4sec) P.value 0.00. PC showed significant decrease in dead neonates compared to recovered (mean; 25.4 and 36.2% for dead and improved) p value 0.04. APTT&PC can be useful as marker of neonatal sepsis mortality. Insignificant difference in PC reported between case and control group. None of the gender, gestational age, delivery mode, sepsis onset, and causative agent showed significant correlation with APTT and PC. The study aimed to assess activated partial thromboplastin time (APTT) and Protein C (PC) among Sudanese neonates with sepsis (case group) compared to healthy neonates (control) and to correlate gender, delivery mode, and gestational age with such coagulation parameter among both groups. Also to correlate APTT and PC with outcome, sepsis onset, and Gram stain typing of the causative agent among case group in order to study haemostatic alteration among neonates with sepsis.

activation of hemostatic system that in turn also considerably influences inflammatory activity (9) .
The study aimed to assess activated partial thromboplastin time (APTT) and Protein C (PC) among Sudanese neonates with sepsis (case group) compared to healthy neonates (control) and to correlate gender, delivery mode, and gestational age with such coagulation parameter among both groups.
Also to correlate APTT and PC with outcome, sepsis onset, and Gram stain typing of the causative agent among case group in order to study haemostatic alteration among neonates with sepsis.

Methods:
The study was prospective cross sectional hospital based study, conducted in Omdurman Maternity hospital, Sudan from June.2013 to April.2015 on 100 Sudanese neonates divided into; cases (neonates with proven sepsis by blood culture), and controls (healthy neonates).
Blood culture for identification of microorganism was done, positive culture included as case sample.
Venous neonatal blood collected and plasma prepared for APTT and PC assessment. PC procedure: 50 microliter of 1/10 diluted (with Owren-Koller buffer) plasma was obtained, then a metal ball was added, then 50 microliter of PC deficient plasma (protein C deficient plasma, Stago. France) was added, 50 microliter of PC activator (highly purifies extract of Agkistrodon contortirx venom. Stago. France) was added and incubated for exactly 180 seconds, then 0.02 M of STA calcium chloride was added (all reagent were pre-warmed at 37C for 15 minutes), then clotting time was counted using semi-automated coagulometer (Stago Stat-4. France), calibrator (STA Uricalbrator. Stago. France) was used as control.

Data analysis:
Data was entered, tabulated, and analyzed by SPSS (statistical program for social and science) IBM
Groups were categorized according to delivery mode; caesarean section and normal vaginal delivery neonates.
APTT prolonged in case group compared to control (47.9 and 37.5 second) (P.value 0.00).
PC decreased in case group compared to control (34.4 and 36.8%) (P.value 0.41).   Discussion: Systemic inflammation is followed by coagulation system activation, and conversely, components of coagulation system significantly affect inflammatory response (10) . Significant prolonged APTT was in line with Krishna I et al (11) and Anggraini.D et al (12) who found prolonged APTT in sepsis patients. APTT significantly decrease in dead neonates, this finding was in line with Christian Niederwanger et al (14) and Benediktsson.S et al (13) who observed APTT prolongation in patients with severe sepsis is associated with increased mortality. The outcome correlate with PC, dead septic neonates have significant lower PC than recovered, this result was in line with Bhat.R et al (15)   Declarations:

Ethics approval and consent to participate
Ethical clearance was obtained from the research ethical committee of Omdurman maternity hospital. Principal investigator obtained an informed consent form the neonates' mothers who included in the study before going on.

Availability of data and material
Individual data are available in digital repository of Alfajr College for Science and Technology. Khartoum, Sudan and can be obtained from the corresponding author on request. Datasets supporting the conclusions of this article are included within the article and it's available in digital repository of Alfajr College for Science and Technology (Soon will be available). Repository.fajr.edu.sd

Funding
The research didn't receive any fund or financial aid.