INDICES OF SYSTEMIC INFLAMMATION IN VERY LOW BIRTH WEIGHT PRETERM INFANTS WITH SEVERE PERINATAL PATHOLOGY
DOI:
https://doi.org/10.11603/24116-4944.2024.2.15087Keywords:
children, preterm birth, hypoxia, perinatal pathology, complete blood count, ratio of NLR, PLR, MLR, systemic inflammation indices SII, SIRI, PIVAbstract
The aim of the study – to study the effectiveness of determining indices of systemic inflammation based on hematological indicators in children with a gestational age at birth of <32 weeks under conditions of hypoxia in perinatal pathology.
Materials and Methods. The primary study cohort comprised 54 children with a gestational age of <32 weeks who exhibited severe forms of perinatal pathology. The comparison cohort consisted of 31 newborns with a gestational age of 34–36/6 weeks who demonstrated satisfactory adaptation in the early neonatal period. A comprehensive clinical and laboratory examination of the newborns was conducted in accordance with standard protocols. Based on the results of the complete blood count, additional ratios of indicators were determined. The following ratios were calculated: NLR (neutrophil to lymphocyte ratio), PLR (platelet to lymphocyte ratio), and MLR (monocyte to lymphocyte ratio); additionally, the following indices were calculated: SII (systemic immune inflammation index); SIRI (systemic inflammation response index); PIV (platelet, neutrophil, monocyte, and lymphocyte index). The statistical analysis was conducted using STATISTICA software (StatSoft Inc., USA, Version 10). Quantitative indicators with a normal distribution were compared using Student's t-test. The probability of differences was considered statistically significant at p<0.0001.
Results and Discussion. The severity of the condition of newborns is accompanied by characteristic changes in complete blood count parameters, including ratios and indices. The results demonstrated specific alterations that suggest the presence of distinctive deviations in the indicators when compared to the control group. This indicates a disruption in the activation of erythroid, myeloid, and granulocyte hematopoiesis pathways in response to hypoxia during the early neonatal period in extremely preterm infants. The utilization of these indicators provides a degree of insight into the pathophysiological alterations occurring in the bodies of children in the context of hypoxic inflammation during preterm birth.
Conclusions. The determination of the ratio of complete blood count (CBC) and systemic inflammation indices represents a significant advancement in the field of laboratory diagnosis for newborns with diverse forms of perinatal pathology. In the cohort of newborns with a gestational age of <32 weeks, the severity of the condition is confirmed by an increase in the NLR index to 0.332, a decrease in the PLR index to 5.331 and MLR to 0.060, a decrease in the SII index to 63.342, the SIRI index to 0.713, and an increase in the PIV index to 199.260. The calculation of the ratio of complete blood count and systemic inflammation indices represents an additional effective criterion for the severity of the condition of newborns. Furthermore, it allows for the objective assessment of certain pathophysiological links of hypoxic damage and their features in preterm infants.
References
1. Russell, C. D., Parajuli, A., Gale, H. J., Bulteel, N. S., Schuetz, P., de Jager, C. P. C., ... & Baillie, J. K. (2019). The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: A systematic review and meta-analysis. The Journal of Infection, 78(5), 339–348. https://doi.org/10.1016/j.jinf.2019.02.006
2. Jiang, J., Mao, Y., & Zhou, Q. (2023). Relationship between hematological parameters and bronchopulmonary dysplasia in premature infants. The Journal of International Medical Research, 51(7), 3000605231187802. https://doi.org/10.1177/03000605231187802
3. Caramelo, I., Coelho, M., Rosado, M., Cardoso, C. M. P., Dinis, A., Duarte, C. B., ... & Manadas, B. (2023). Biomarkers of hypoxic-ischemic encephalopathy: A systematic review. World Journal of Pediatrics, 19(6), 505–548. https://doi.org/10.1007/s12519-023-00698-7
4. Yilmaz, A., Cebi, M. N., & Vural, M. (2023). Long-term neurodevelopmental effects of exclusively high cord lactate levels in term newborn. The Journal of Maternal-Fetal & Neonatal Medicine, 36(2), 2284115. https://doi.org/10.1080/14767058.2023.2284115
5. Yamane, T. (2020). Cellular basis of embryonic hematopoiesis and its implications in prenatal erythropoiesis. International Journal of Molecular Sciences, 21(24), 9346. https://doi.org/10.1590/1984-0462/;2019;37;3;00008
6. Rolim, A. C. B., Lambert, M. A., Borges, J. P. G., Abbas, S. A., Bordin, J. O., Junior, D. M. L., ... & Santos, A. M. N. D. (2019). Blood cells profile in umbilical cord of late preterm and term newborns. Revista Paulista de Pediatria, 37(3), 264–274. https://doi.org/10.1590/1984-0462/;2019;37;3;00008
7. Ceran, B., Alyamaç Dizdar, E., & Sarı, F. N. (2024). Diagnostic role of systemic inflammatory indices in infants with moderate-to-severe hypoxic ischemic encephalopathy. American Journal of Perinatology, 41(3), 248–254. https://doi.org/10.1055/a-1673-1616
8. Karapati, E., Valsami, S., Sokou, R., Pouliakis, A., Tsaousi, M., Sulaj, A., ... & Boutsikou, T. (2024). Hemostatic profile of intrauterine growth-restricted neonates: Assessment with the use of NATEM assay in cord blood samples. Diagnostics, 14(2), 178. https://doi.org/10.3390/diagnostics14020178
9. Twisselmann, N., Pagel, J., Künstner, A., Weckmann, M., Hartz, A., Glaser, K., ... & Härtel, C. (2021). Hyperoxia/hypoxia exposure primes a sustained pro-inflammatory profile of preterm infant macrophages upon LPS stimulation. Frontiers in Immunology, 12, 762789. https://doi.org/10.3389/fimmu.2021.762789
10. Olofsson, P. (2023). Umbilical cord pH, blood gases, and lactate at birth: Normal values, interpretation, and clinical utility. American Journal of Obstetrics and Gynecology, 228(5S), S1222–S1240. https://doi.org/10.1016/j.ajog.2022.07.001
11. Liu, X., Manninen, T., Capper, A. M., Jiang, X., Ellison, J., Kim, Y., ... & Ferriero, D. M. (2024). Brain metabolism after therapeutic hypothermia for murine hypoxia-ischemia using hyperpolarized [1-13C] pyruvate magnetic resonance spectroscopy. NMR in Biomedicine, e5196. https://doi.org/10.1002/nbm.5196
12. Cakir, U., Tayman, C., & Yildiz, D. (2023). Role of systemic inflammatory indices in the prediction of moderate to severe bronchopulmonary dysplasia in preterm infants. Archivos de Bronconeumología, 59(4), 216–222. https://doi.org/10.1016/j.arbres.2023.01.003
13. Toptan, H. H., Tezel, K. G., & Özek, E. (2024). Inflammatory and hematologic liver and platelet (HALP) scores in hypothermia-treated hypoxic-ischemic encephalopathy (HIE). Children, 11(1), 72. https://doi.org/10.3390/children11010072
14. Cakir, U., Tugcu, A. U., & Yildiz, D. (2024). Evaluation of the effectiveness of systemic inflammatory indices in the diagnosis of respiratory distress syndrome in preterm infants with gestational age ≤32 weeks. American Journal of Perinatology, 41(Suppl. 1), e1546–e1552. https://doi.org/10.1055/a-2051-8544
15. Aguirre-Escojido, A., Padilla-Soto, A., Guevara-González, J. J., Reyes-Sosa, A. M., González, A. P., Paque-Bautista, C., ... & Sosa-Bustamante, G. P. (2023). Prognostic utility of inflammatory indexes in critically ill newborns. Revista Médica del Instituto Mexicano del Seguro Social, 61(Suppl. 2), 171–177.
16. Şahin, E., Kefeli, U., Zorlu, Ş., Seyyar, M., Akdag, M. O., Sanci, P. C., ... & Uygun, K. (2023). Prognostic role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, and pan-immune-inflammation value in metastatic castration-resistant prostate cancer patients who underwent ^177Lu-PSMA-617. Medicine, 102(47), e35843. https://doi.org/10.1097/MD.0000000000035843
17. Millar, L. J., Shi, L., & Molnár, Z. (2017). Neonatal hypoxia ischaemia: Mechanisms, models, and therapeutic challenges. Frontiers in Cellular Neuroscience, 11, 78. https://doi.org/10.3389/fncel.2017.00078
18. Humberg, A., Fortmann, I., & Göpel, W.; German Neonatal Network; German Center for Lung Research; PRIMAL Consortium. (2020). Preterm birth and sustained inflammation: Consequences for the neonate. Seminars in Immunopathology, 42, 451–468. https://doi.org/10.1007/s00281-020-00803-2
19. Gauda, E. B., & McLemore, G. L. (2020). Premature birth, homeostatic plasticity and respiratory consequences of inflammation. Respiratory Physiology & Neurobiology, 274, 103337. https://doi.org/10.1016/j.resp.2019.103337
20. Jawdeh, E. G. A., Huang, H., & Giannone, P. (2021). Intermittent hypoxemia in preterm infants: A potential proinflammatory process. American Journal of Perinatology, 38(12), 1313–1319. https://doi.org/10.1055/s-0040-1712951
21. Twisselmann, N., Pagel, J., Künstner, A., Weckmann, M., Hartz, A., Glaser, K., ... & Härtel, C. (2021). Hyperoxia/hypoxia exposure primes a sustained pro-inflammatory profile of preterm infant macrophages upon LPS stimulation. Frontiers in Immunology, 12, 762789. https://doi.org/10.3389/fimmu.2021.762789
22. Hrubaru, I., Motoc, A., Moise, M. L., Miutescu, B., Citu, I. M., Pingilati, R. A., ... & Citu, C. (2022). The predictive role of maternal biological markers and inflammatory scores NLR, PLR, MLR, SII, and SIRI for the risk of preterm delivery. Journal of Clinical Medicine, 11(23), 6982. https://doi.org/10.3390/jcm11236982
23. Thayyil, S., Montaldo, P., Krishnan, V., Ivain, P., Pant, S., Lally, P. J., ... & Shankaran, S. (2023). Whole-body hypothermia, cerebral magnetic resonance biomarkers, and outcomes in neonates with moderate or severe hypoxic-ischemic encephalopathy born at tertiary care centers vs other facilities: A nested study within a randomized clinical trial. JAMA Network Open, 6(5), e2312152. https://doi.org/10.1001/jamanetworkopen.2023.12152
24. Wang, S., Wan, Y., & Zhang, W. (2024). The clinical value of systemic immune inflammation index (SII) in predicting the severity of hospitalized children with Mycoplasma pneumoniae pneumonia: A retrospective study. International Journal of General Medicine, 17, 935–942. https://doi.org/10.2147/IJGM.S451466
Downloads
Published
Issue
Section
License
Copyright (c) 2025 О. С. Годованець
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms:
1. The authors reserve the right to authorship of the work and pass the journal right of first publication of this work is licensed under a Creative Commons Attribution License, which allows others to freely distribute the work published with reference to the authors of the original work and the first publication of this magazine.
2. Authors are entitled to enter into a separate agreement on additional non-exclusive distribution of work in the form in which it was published in the magazine (eg work place in the electronic repository institution or publish monographs in part), provided that the reference to the first publication of this magazine.
3. Policy magazine allows and encourages authors placement on the Internet (eg, in storage facilities or on personal websites) manuscript of how to submit the manuscript to the editor and during his editorial processing, since it contributes to productive scientific discussion and positive impact on the efficiency and dynamics of citing published work (see. The Effect of Open Access).
