THE RELATIONSHIP BETWEEN SERUM SELENIUM LEVELS AND SEVERITY OF NEONATAL SEPSIS IN UNIVERSITY OF BENIN TEACHING HOSPITAL, BENIN CITY

Abstract

Sepsis remains a major cause of morbidity and mortality in neonates despite advances in
antimicrobial therapy, hand hygiene practices, life support measures and the early
detection of risk factors. Predictors of severity and mortality in neonatal sepsis have been
elucidated over the years with the aim of modifying the identified predictors to improve
outcome. Selenium, a micro-nutrient with immune modulatory functions has been thought
to have an effect on the severity of sepsis and outcome of patients with sepsis. Studies on
selenium levels in neonatal sepsis are lacking thus this prospective cross-sectional study
was undertaken to determine the serum selenium levels among neonates with sepsis and
their healthy controls and to assess whether any relationship existed between the selenium
levels and severity of sepsis.
The study was carried out at the Special Care Baby Unit (SCBU) of the University of
Benin Teaching Hospital. The patients were neonates who had risk factors for sepsis,
clinical features of sepsis and abnormal sepsis screen. Patients with positive blood,
cerebrospinal fluid (CSF) or urine cultures constituted the proven sepsis cohorts while
patients with negative cultures formed the probable sepsis group. Controls were healthy
age and sex matched neonates recruited from the immunization clinics and maternity
wards. Selenium levels were determined using flame absorption spectrophotometry and
values above 70µg/L were considered normal.
Two hundred and seven neonates were admitted during the study period and of these, 76
(36.7%) were recruited as patients. Of the 76 patients, 47 (61.8%) were males and 29
(38.2%) were females. The gender distribution was equal in the control group (  2 = 0.00,
df = 1, p = 1.00). The ages of the patients ranged between 1-21 days while for the
controls it was 1-16 days. There was no statistically significant difference between the
ages of the patients and controls (t = 1.36, df =150, p = 0.17).
The serum selenium levels of the patients ranged from 46.10 to 121.40µg/L with a mean
of 74.12 (21.50) µg/L while the corresponding values for the controls were 69.70-140.20
µg/L and 100.33 (17.85) µg/L. The mean of the serum selenium levels of the patients was
significantly lower than that of the controls (t = 8.16, df = 150, p <0.001). Of the 76
patients, 23 (30.3%) had culture proven sepsis while 53 (69.7%) had probable sepsis. The
mean of the serum selenium levels in patients with culture proven sepsis was significantly
lower than that of patients with probable sepsis (t = 6.73, df = 74, p = <0.001). Twenty
one (27.6%) of the patients had severe sepsis with multiple organ involvement and all had
serum selenium levels below the normal level. The mean serum selenium levels of the
babies with severe sepsis was significantly lower than that of patients without severe
sepsis (t = 4.62, df = 74, p = < 0.001).
Serum selenium levels of the patients were found to have significant positive correlations
with platelet counts and haemoglobin concentrations (r = 0.48, p = <0.001; r = 0.52, p =
<0.001) respectively while a negative correlation was found with micro-ESR (r = -0.32, p
= 0.004).
The mortality rate was high at 26.3% and patients who died had significantly lower serum
selenium levels than those who survived (t = 4.73, df = 74, p < 0.001). Also, on multiple
logistic regression, serum selenium level was the only significant independent predictor of
mortality (O.R = 0.907, C.I = 0.836, 0.984, p = 0.019). Thus, the odds of dying from
neonatal sepsis were increased with lower selenium levels.
The findings from the present study suggest that serum selenium levels are significantly
reduced in neonates with sepsis and play a significant role in the outcome of neonatal
sepsis.

THE RELATIONSHIP BETWEEN SERUM SELENIUM LEVELS AND SEVERITY OF NEONATAL SEPSIS IN UNIVERSITY OF BENIN TEACHING HOSPITAL, BENIN CITY