Maternal complete blood count parameters and systemic inflammatory index in prediction of the hospitalization in newborn intensive care unit

Objective: Maternal inflammation, which is involved in the etiology of late preterm labor, initiates an inflammatory response in the fetus, causing ischemia and damage to the growing tissues of the fetus. This condition has been associated with poor neonatal outcomes after birth. In inflammation-related late preterm deliveries, both the risks of prematurity and the risks of fetal systemic inflammatory response affect the newborn. Antenatal estimation of newborn outcomes is important in the follow-up of pregnant women in the late preterm period, where a consensus on patient approach cannot be achieved. Based on this mechanism, the aim of our study is to determine the degree of maternal inflammation with new generation inflammation biomarkers and to examine the relationship between the need for neonatal intensive care unit and the degree of inflammation in the maternal systemic circulation. Materials and Methods: This retrospective study was conducted in Ankara City Hospital Gynecology and Obstetrics Clinic, between 01/10/2019-30/04/2020, between 34 weeks 0 days and 36 weeks 6 days, who were admitted to the delivery room with the diagnosis of spontaneous late preterm labor. A total of 153 patients with intact membranes were included. Patients with maternal infection (urinary tract infection, upper respiratory tract infection, etc.), maternal tachycardia, fetal tachycardia, fever, chorioamnionitis, gestational hypertension, gestational diabetes, preeclampsia-eclampsia, maternal systemic inflammatory disease, covid-19 diagnosis excluded from the study. The patients were divided into two groups as 70 patients whose babies required hospitalization in the neonatal intensive care unit (NICU) and 83 patients who did not require hospitalization in NICU. Demographic and clinical characteristics of the patients were recorded. Parameters obtained from maternal blood whole taken during admission to the delivery room were recorded. The 1st and 5th minute Apgar scores of the newborns, their birth length and weight, whether they were admitted to the neonatal intensive care unit, and the indication and duration of hospitalization were recorded. vi The "Independent Sample-t" test (t-table value) method was used to compare the measurement values of two independent groups, in accordance with the parametric methods, for the data conforming to the normal distribution. For measurement values that do not conform to the normal distribution, in accordance with non-parametric methods, the "Mann-Whitney U" test (Z-table value) is used to compare the measurement values of two independent groups, and the "Kruskal-Wallis H" test for the comparison of the measurement values of three or more independent groups ( χ2-table value) method was used. Spearman correlation coefficient was used to examine the relationship between measurement values that do not have a normal distribution. Binary Logistic Regression, Backward:LR method was used to examine the risk status of neonatal intensive care hospitalization. Results: A total of 153 patients, 70 of whom were hospitalized in the neonatal intensive care unit (NICU) and 83 patients who were not hospitalized in the neonatal intensive care unit, were included in our study. When the two groups were compared in terms of demographic characteristics, no statistically significant difference was found between age, gravida, parity, gestational week, number of days of gestation, and time from hospitalization to delivery (p0.05). There was no statistically significant relationship between the groups and the history of preterm birth, route of delivery, baby's gender and antenatal steroid administration (p>0.05). The groups are independent and homogeneous in terms of the specified characteristics. Hemoglobin, lymphocyte percentage, lymphocyte, monocyte percentage and MPV values were statistically significantly higher in the group that did not require hospitalization in the neonatal intensive care unit compared to those hospitalized in NICU (p<0.05). WBC, PLT, neutrophil percentage, neutrophil, NLR, PLR, MLR and SII values were statistically significantly higher in the group requiring hospitalization in the neonatal intensive care unit compared to the group not requiring admission to NICU (p<0.05). There was no significant difference between the two groups in terms of red blood cell distribution volume (RDW) and mean red cell volume (MCV) (p=0.24 and p=0.41, respectively). As a result of the Backward:LR logistic regression analysis, which was applied by including all the parameters found to be significant in the univariate analysis in the model established with the risk status of admission to the neonatal intensive care unit; vii according to the optimal model; WBC, percentage of monocytes and SII value were found to be significant risk factors on NICU admission risk status (p<0.05). When the WBC value increases by 1 unit, the risk of NICU hospitalization will increase 3.400 times, when the monocyte % value increases by 1 unit, the risk will increase 1.948 times (94.8%), and when the SII value increases by 1 unit, the risk will increase 1.006 times (0.6%). The optimal mean amplitude (min) value for SII was found to be 943.22 with 80.0% sensitivity and 84.3% specificity (AUC=0.885; p<0.05). There is no statistically significant relationship between the gestational week of the patients in both groups and NLR, PLR, MLR and SII values (p> 0.05). In the group requiring hospitalization in the neonatal intensive care unit, there was no statistically significant relationship between the length of stay of the infants in the intensive care unit and the NLR, PLR, MLR and SII values measured in maternal blood (p>0.05). Conclusion: Our study revealed that the SII value, which can be easily measured from maternal complete blood count, can predict the risk of hospitalization in the intensive care unit in the late preterm period. No relation was found between the SII value and the length of stay in the NICU. It was determined that the NLR, PLR, MLR and SII values in the complete blood count taken from the mothers of the babies who needed to be admitted to the neonatal intensive care unit were statistically significantly higher. No correlation was found between gestational week and inflammation markers. It has been concluded that the SII value, which can be simply added to the complete blood count report, will be a guide for the estimation of neonatal outcomes.