Laboratory manifestations of fetal inflammatory response syndrome in extremely premature newborns

Authors

DOI:

https://doi.org/10.18370/2309-4117.2024.73.68-73

Keywords:

fetal inflammatory response syndrome, premature birth, extremely premature newborns, leukocytosis, leukopenia, anemia, thrombocytopenia, C-reactive protein, procalcitonin

Abstract

Background. Fetal inflammatory response syndrome (FIRS) is a pathological response to changes in the chorion and is manifested by inadequate cytokine production and endothelial dysfunction.
Objective of the study: to investigate laboratory changes in extremely premature newborns depending on the presence of FIRS criteria.
Materials and methods. The prevalence of umbilical cord blood leukocytosis and leukopenia, anemia and thrombocytopenia, as well as increased levels of C-reactive protein and procalcitonin in 403 premature newborns was analyzed depending on the presence of FIRS laboratory criteria. Newborns were divided depending on the gestational age (I and II groups – 24–27 weeks, III and IV groups – 28–34 weeks), and the presence of prenatal rupture of the fetal membranes (I and III groups) or the onset of labor with intact membranes (II and IV groups).
Results. FIRS increases the frequency of leukopenia, anemia, and thrombocytopenia in extremely premature newborns, and the frequency of leukocytosis and the appearance of young forms of leukocytes in premature infants from early preterm labour. Elevated levels of C-reactive protein and procalcitonin were more common in cases of premature rupture of membranes than in cases of labor with intact amniotic sac. This frequency did not depend on the presence of FIRS in extremely premature newborns; such dependence was outlined for premature infants from early preterm labour.
Conclusions. Leukopenia is more often found in premature babies from very early premature births than from early premature births. More than 20 × 109/ml leukocytosis and an increased proportion of young forms of neutrophils of more than 10% were found in the case of premature rupture of the fetal membranes, more often than during childbirth with intact membranes. In extremely premature newborns FIRS was accompanied by an increased frequency of leukopenia, thrombocytopenia, and anemia. FIRS do not increase levels of C-reactive protein and procalcitonin in extremely premature newborns.

Author Biography

V.V. Bila, Institute of Postgraduate Education of the O.O. Bogomolets National Medical University; KNP Kyiv City Perinatal Centre, Kyiv

PhD, associate professor, head of the Department of Obstetrics, Gynaecology and Neonatology;
Medical director

References

  1. Jung E, Romero R, Yeo L, et al. The fetal inflammatory response syndrome: the origins of a concept, pathophysiology, diagnosis, and obstetrical implications. Semin Fetal Neonatal Med. 2020 Aug;25(4):101–46. doi: 10.1016/j.siny.2020.101146
  2. Zahorodnia O, Motsiuk Y, Amerkhanova T. Polohova diialnist yak proiav systemnoi zapalnoi reaktsii (Ohliad literatury). Reproductive health of woman. 2023;4:79–84. DOI: 10.30841/2708-8731.4.2023.285769
  3. Zahorodnia O, Yarotska Y. Morfolohiia platsenty – vid teorii do praktyky. Reproductive health of woman. 2021;9–10(54–55):67–72. DOI: 10.30841/2708-8731.9-10.2021.252595
  4. Gomez R,Romero R, Ghezzi F, et al. The fetal inflammatory response syndrome. Am J Obstet Gynecol. 1998 Jul;179(1):194–202. DOI: 10.1016/S0002-9378(98)70272-8
  5. Wong Y, Khong T. Changing Laboratory Practice for Early Detection of a Fetal Inflammatory Response: A Contemporary Approach. Diagnostics. 2023; Jan 29;13(3):487. DOI: 10.3390/diagnostics13030487
  6. Yap V, Jeffrey M. Mechanisms of brain injury in newborn infants associated with the fetal inflammatory response syndrome. Semin Fetal Neonatal Med. 2020 Aug;25(4):101–10. DOI: 10.1016/j.siny.2020.101110
  7. Francis F, Bhat V, Mondal N, et al. Fetal inflammatory response syndrome (FIRS) and outcome of preterm neonates – a prospective analytical study. J Matern Fetal Neonatal Med. 2019 Feb;32(3):488–92. doi: 10.1080/14767058.2017.1384458.
  8. Herrera C, Kadari P, Pruszynski J, Mir I. Impact of maternal infection on outcomes in extremely preterm infants. Pediatr Res. 2024 Jan;95(2):573–8. doi: 10.1038/s41390-023-02898-3.
  9. Mir I, Sánchez-Rosado M, Reis J, et al. Impact of fetal inflammatory response on the severity of necrotizing enterocolitis in preterm infants. Pediatr Res. 2024 Apr;95(5):1308–15. doi: 10.1038/s41390-023-02942-2.
  10. Collins A, Weitkamp J, Wynn J. Why are preterm newborns at increased risk of infection? Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103:F391–F394.
  11. Bartkeviciene D, Pilypiene I, Drasutiene G, et al. Leukocytosis as a prognostic marker in the development of fetal inflammatory response syndrome. Libyan Journal of Medicine. 2013 Oct 24;8(1). DOI: 10.3402/ljm.v8i0.21674
  12. Nakamura T, Hatanaka D, Kusakari M, et al. Neonatal Leukemoid Reaction with Fetal Inflammatory Response Syndrome Is Associated with Elevated Serum Granulocyte Colony Stimulating Factor and Interleukin-6. The Tohoku Journal of experimental medicine. 2018 Feb;244(2):145–9. DOI: 10.1620/tjem.244.145
  13. Shah J, Balabramaniam T, Yang J, Shah P. Leukopenia and Neutropenia at Birth and Sepsis in Preterm Neonates of <32 Weeks’ Gestation. Am J Perinatol. 2022 Jul;39(09):0965–0972 DOI: 10.1055/s-0040-1721133
  14. Gaetano C. Neutropenia in preterm infants. Current Pediatric Reviews 2023.19(4):352–6(5) DOI: 10.2174/1573396319666221216121530
  15. Catal F, Tayman C, Tonbul A. Mean Platelet Volume (MPV) may Simply Predict the Severity of Sepsis in Preterm Infants. Clin.lab.2014:60(7):1–8 DOI:10.7754/Clin.Lab.2013.130501 ·
  16. Leush SS, Protsyk MV. Hemostasis in vessels of the umbilical cord in premature and extremely premature newborns. Ukrainian Journal Health of Woman. 2023;4(167):35–9; doi 10.15574/HW.2023.167.35.
  17. Chen C, Essien M, Johnson A. Use of mean platelet volume in the assessment of intrauterine infection in newborns with combined thrombocytopenia and leukopenia at birth. J Matern Fetal Neonatal Med. 2019. Feb;34(3):346–52. DOI: 10.1080/14767058.2019.1608174
  18. Koloskova O, Bogutska N, Vlasova O, et al. Some immunological biomarkers of the severity of neonatal sepsis in newborns depending on different inflammatory response. Child’s health. 2023;18(2):127–34. DOI: 10.22141/2224-0551.18.2.2023.1573
  19. Hofer N, Zacharias E, Müller W, Resch B. An update on the use of C-reactive protein in early-onset neonatal sepsis: current insights and new tasks. Neonatology. 2012;102(1):25–36. doi: 10.1159/000336629.
  20. Sofijanova A, Bojadzieva S, Naunova-Timovska S, et al. Relationship of serum procalcitonin levels and c-reactive protein levels in newborns with sepsis in different types of respiratory support in intensive care unit. Arch Pub Health. 2021 Jun;13(1):39–47. DOI:10.3889/aph.2021.5995
  21. Jekarl D, Lee S., Lee J. et al. Procalcitonin as a diagnostic marker and IL-6 as a prognostic marker for sepsis. Diagnostic Microbiology and Infectious Disease. 2013 Apr;75(4):342–7. DOI: 10.1016/j.diagmicrobio.2012.12.011.
  22. Areia A, Areia M, Mota-Pinto A. Procalcitonin in preterm rupture of membranes: a systematic review and meta-analysis. Arch Gynecol Obstet. 2021 Apr;303(4);917–24. DOI: 10.1007/s00404-020-05820-y
  23. Cui X, Shi Y, Sun T, Fu J. Role of umbilical cord blood procalcitonin in the noninvasive diagnosis of fetal inflammatory response syndrome: a pilot study. Research Square. 2024 Jun 8. DOI: 10.21203/rs.3.rs-1723219/v1
  24. Walker S, Harding I, Soomro K. et al. An evaluation into the use of procalcitonin levels as a biomarker of bacterial sepsis to aid the management of intrapartum pyrexia and chorioamnionitis. AJOG Glob Rep. 2022 Aug;2(3):100064. doi: 10.1016/j.xagr.2022.100064.
  25. Kaneko M, Muraoka J, Yamada N, Kodama Y. Association between Chorioamnionitis Severity and Procalcitonin Levels in Umbilical Venous Blood. Clin. Exp. Obstet. Gynecol. 2022;49(7), 160. DOI: 10.31083/j.ceog4907160

Published

2024-10-18

How to Cite

Bila, V. (2024). Laboratory manifestations of fetal inflammatory response syndrome in extremely premature newborns. REPRODUCTIVE ENDOCRINOLOGY, (73), 68–73. https://doi.org/10.18370/2309-4117.2024.73.68-73

Issue

Section

Laboratory diagnosis