We read with interest the recent article in the present journal [1] on the utility of 15 discrete biomarkers in the diagnostics of neonatal sepsis. The authors concluded that no single ideal biomarker has so far become established. We here wish to pay attention to still one biomarker, namely Ischaemia modified albumin (IMA).

IMA is a new marker of tissue ischaemia,[2–4] based on the observation that the affinity of albumin for cobalt is reduced after N-terminal modification.[5] There is also evidence suggesting that IMA is increased in diseases associated with oxidative stress.[6] Because inflammation reduces the capacity of albumin to bind cobalt, serum IMA has newly gained interest as a marker of inflammation and infection.[7] On that basis we evaluated the role of serum IMA as an early marker in the diagnosis of neonatal sepsis. We carried out a cross-sectional comparative study in the neonatal ICU unit of the paediatric department in Suez Canal University Hospital in the period from December 2013 to November 2014 on two groups; The patient group consisted of 30 (15 male, 15 female) patients with early onset sepsis age, at a mean of 35.4 weeks and the control group consisted of 30 (14 male, 16 female) healthy neonates with age and sex matched from a healthy mother having no antenatal infections or diseases, no history of antibiotic treatment, no perinatal asphyxia, no observed congenital anomalies, no postpartum disorders and no suspicion of neonatal sepsis, with a mean age of 36.5 weeks. Inclusion criteria for patient group were that neonates with neonatal sepsis based on clinical, laboratory and positive blood culture results. Exclusion criteria were neonates with conditions causing oxidative stress like acute renal injury, metabolic disease, cyanotic congenital heart disease, major congenital malformation, perinatal asphyxia, intracranial haemorrhage, necrotising enterocolitis, neonates treated with indomethacin, ibuprofen and amphotericin B and neonates with patent ductus arteriosus. Ethical approval was taken from the ethical committee, Suez Canal University and informed consent was obtained from parents of all neonates. Complete history and complete clinical examination were done for all the included neonates, also laboratory investigations including complete blood count, C-reactive protein, blood culture and measurement of ischaemia-modified albumin levels using ELISA were done. All the data were analysed with the Statistical Package for Social Science (SPSS) computer program, version 20 Microsoft Window. The results of each group are expressed as the mean value6Standard deviation of the mean. Differences between groups were assessed by using t-test; also, some