الفهرس 
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Abstract
Sepsis is a one major cause of morbidity and mortality in pediatric patients since it can leads to SIRS, organ failure complications and hospitalization for long durations which can be very costly on health care system all around the world (Torio., 2017).
A serious complication of sepsis is intestinal failure which is a severe decrease in the GI function that leads to an inadequate absorption of nutrients, water and electrolytes to a level that necessitates providing parentral nutrition. (Pironi et al., 2015).
The aim of the current study was to test effect of lactofferin supplementation for improving gut barrier function, prognosis and the outcome of septic patients using plasma citrulline level as a marker of the functional enterocytic mass.
The present study was double armed single blinded therapeutic clinical trial study conducted on 40 children who were admitted to the PICUs of Ain Shams University Hospitals with diagnosis of pediatric sepsis, their ages ranged from 1-180 months. There were 23 males and 17 females whose results were compared to 10 healthy controls.
In the current study, established sepsis was diagnosed using SOFA score, and the degree of GIT failure was assessed using GIF score.
The patients were randomly divided into 2 groups:
• Twenty patients were septic patients with gut failure who did not receive lactoferrin.
• Twenty patients were septic patients with gut failure who received lactoferrin.
• Ten healthy controls.
As regards the fate of the patients in the whole study group, the mortality was 20/40 (50%), with no statistical difference between the two groups with p value >0.05.
There was significant difference between the median range of plasma citrulline level in survivors and non-survivors, it was < 10 mmol/l in non survivors and > 20 mmol/l in survivors with p value of 0.034 .
When comparing SOFA score in survivors and non-survivors, it was high in non survivors with p value of 0.020 .
In the present study we compared the two studied groups (receiving and non receiving lactoferrin) as regards the following points:
1) Clinical data and outcome
2) ABG analysis
3) Citrulline and Lactate levels
Also there was no statistical difference between the two studied groups as regards the descriptive data with p value >0.05.
As regards the clinical data of the included patients, there were no statistically significant differences between both study groups in terms of cardiorespiratory data, liver function tests, hematological and biochemical work up, GIF and SOFA scores.
This indicates the similarity of the two studied groups as regards descriptive data, clinical data and degree of organ dysfunction before the lactofferin supplementation.
As regards mortality, need of mechanical ventilation and need of inotropes in the studied patients there were no statistical differences between the two studied groups.
Results of ABG analysis (pH, PaCO2 and HCO3 levels) in the studied patients there were no statistical difference between the two studied groups with p value >0.05.
By comparing the citrulline levels in the two studied groups we found that there was no statistical difference between them with p value >0.05, this means that the supplementation with lactoferrin as assessed by the citrulline biomarker doesn’t show any statistical differences between the two groups.
There were not any significant correlation between citrulline and (SOFA and GIF scores) with p value >0.05.
While there was significant negative correlation between lactate and citrulline in patients after receiving lactoferrin with p value of 0.024.
There were not any significant correlation between citrulline and liver function tests, kidney function tests, blood electrolytes, blood indices and arterial blood gases with p value >0.05.
Also there were not any significant correlation between citrulline and the characteristics of the studied children as age, height, weight or body mass index with p value >0.05.