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Urine Metabolic Screening in Neonates with Abrupt Clinical Deterioration in Absence of Sepsis Risk Factors

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Author(s): Ayman H. Al Hefnawy | Mostafa M. Ahmady | Hesham Al Saka | Maha Atfy

Journal: Journal of Medical Sciences
ISSN 1682-4474

Volume: 8;
Issue: 1;
Start page: 28;
Date: 2008;
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Keywords: Screening | urine | urine | metabolic disorders | sick neonates

ABSTRACT
This study was conducted at the Neonatal Intensive Care Unit (NICU),Zagazig University Hospitals during a period of 20 months, aiming at increasing the awareness towards metabolic diseases among neonates with abrupt clinical deterioration in the absence of sepsis risk factors, hoping for early detection by using simple urine tests. The study included 115 newborns divided into: 95 newborns with abrupt clinical deterioration after a period of apparently healthy conditions and in the absence of sepsis risk factors and 20 healthy newborns as controls. Patients were subjected to full history taking, thorough clinical and neurologic examination and investigations that were done in NICU such as CBC, CRP, blood culture, serum electrolytes, blood glucose, arterial blood gases and serum ammonia. The following urine screening tests were done to all newborns: Ferric chloride test, nitrosonaphthol test, 2,4 dinitrophenyl hydrazine test, cyanide nitroprusside test, Benedict test, glucose oxidase and urinary ketones. Our results included +ve 2,4 dinitrophenyl hydrazine test in 51.6% of cases,+ve urinary ketones in 45.3% of cases, +ve ferric chloride test in 31.6% of cases,+ve Benedict test in 16.8% of cases, +ve cyanide nitroprusside test in 10.5% of cases,+ve nitrosonaphthol and glucose oxidase tests in 8% of cases. Three out of the 13 cases with sepsis had +ve urine tests, indicating that sepsis does not exclude screening for metabolic disorders. All urinary screening tests are -ve in the control group. We concluded that all neonates with abrupt deterioration of clinical conditions should be screened for metabolic disorders by simple urine tests which are rapid, easy and inexpensive,for early diagnosis and early treatment of these disorders with better outcome.
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