Retrospective evaluation of proinflammatory markers in very low birth weight infants with bronchopulmonary dysplasia (BDP) in terms of risk for BDP developmen

Objective: Bronchopulmonary dysplasia is a major cause of morbidity and mortality in premature infants. This study aimed to identify proinflammatory markers (NLR, MLR, PLR, SII, SIRI, DNI, and PIV) that could predict BPD development in very low birth weight preterm infants, in order to define the target patient group requiring early postnatal therapeutic intervention. Materials and Methods: This retrospective study included infants born at ≤32 gestational weeks with a birth weight <1500 gram who were followed between 2020 and 2024 in the Neonatal Intensive Care Unit of Akdeniz University Faculty of Medicine. Demographic, prenatal, and postnatal data, along with proinflammatory indices calculated from complete blood counts obtained on days 0-1-5 and 28., were analyzed. BPD diagnosis and grading were based on the Jobe and Bancalari classification. Infants were categorized as no, mild, moderate, or severe BPD. Data were compared statistically among groups, and receiver operating Characteristic curve analysis was performed to determine significant markers and optimal cut-off values. Results: Of the 141 infants included in the study, 43.3% did not develop BPD, while 31.9% had moderate or severe BPD. The mean gestational age was 28.10±1.87 weeks, and the mean birth weight was 1068±245 gr. NLR and MLR levels were significantly higher in the severe BPD group compared to the no/mild BPD groups. DNI values were significantly higher in both mild and severe BPD groups compared with the non-BPD group. SII, SIRI, and PIV levels were markedly elevated in the severe BPD group compared with all other groups. Overall, PIV was identified as the strongest predictor of severe BPD, hemoglobin showed a protective effect, and leukocyte levels provided limited predictive value. Conclusion: Inflammatory hematologic indices are valuable biomarkers for predicting the development and severity of BPD in very low birth weight preterm infants. These parameters, easily derived from routine hemograms, may assist in identifying high-risk infants early and contribute to the development of preventive strategies when evaluated together with clinical risk factors. Validation through prospective multicenter studies is warranted. Keywords: Bronchopulmonary Dysplasia (BPD), Proinflammatory Markers, Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), Platelet-to-Lymphocyte Ratio (PLR), Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), Delta Neutrophil Index (DNI), Pan-Immune Inflammation Value (PIV)