Preterm yenidoğanlarda immünglobulin düzeyleri

Introduction and Aim: Sepsis is one of the leading cause of mortality and morbidity in newborns. The risk is higher in preterm newborns. Premature immune system and low levels of serum immunoglobulins (Ig) may be associated with higher risk of mortality in preterm newborns. In this study we aim to find out the serum immunoglobulin levels of preterm babies who are ≤ 32 weeks of, define normal range of serum immunoglobulin (G, A, M) levels for each gestational age and establish any associations between serum Ig levels and neonatal mortality/morbidity causes. Material and Method: The data of preterm newborns retrospectively collected from the file records. Babies with major congenital anomalies and chrosomal anomalies were excluded. The serum Ig G, A, M levels were examined in the first 7 days postnatally. The serum Ig levels of babies were recorded before and after intravenous immunoglobulin (IVIG) and IgM-enriched immunoglobulin (Pentaglobin®) replacement therapy. The newborns are divided in to two groups as <28 and 28-32+6/7 weeks of gestational age to minimize the difference between gestational ages. The associations between primary adaptation, sepsis, respiratory distress syndrome, patent ductus arteriosus, retinopathy of prematurity, intraventriculer hemorrhage, seizures and gestational age are investigated. Results: The mean serum Ig G levels of the babies whose gestational ages are 28 weeks and above were resulted higher than the babies with the gestational age below 28 weeks and this difference found to be statistically significant (p=0,001). When the patients were classified according to their birthweight as under 1000 g, between 1000-15000 g and above 1500 g, a statistically significant difference was found between the first postnatal IgG levels (p=0,001). There was statistically significant difference between being treated with supportive immunoglobulins and IVH and PDA in patients whose gestational weeks are below 28 weeks (p values respectively, p=0,014, p=0,039). There was a statistically significant relationship between being treated with supportive immunoglobulins and RDS, BPD, NEC, IVH, ROP, PDA, seizures and proven sepsis in patients whose gestational ages are 28 weeks and above (p=0,001, p=0,001, p=0,001, p=0,005, p=0,001, p=0,001, p=0,001, p=0,001 respectively). There was a weak, significant negative correlationship between noninvasive and invasive ventilation period and serum IgG levels in patients with ≥28 weeks of gestation (r=-.289, p=0,001), (r=-.244, p=0,001). When living and dead patients we are compared, serum IgG levels were found to be higher in surviving patients on the postnatal first day in both groups and this result was found to be statistically significant (p=0,002, p=0,001 respectively). Postnatal first day IgG levels of babies born below 28 weeks of gestation and whose mothers had preeclampsia and oligohydroamnios were found to be statistically significantly higher than th IgG levels of babies whose mothers did not have preeclampsia and oligohydroamnios (p values respectively, p=0,007, p=0,027). Postnatal first day IgG levels of babies born 28 weeks and above gestational age and whose mothers had hypertension and preeclampsia were found to be statistically significantly higher than th IgG levels of babies whose mothers did not have hypertension and preeclampsia (p values respectively, p=0,04, p=0,017). Conclusions: It was observed that IgG levels were increased as the gestational age and birthweight of the patients increased, but IgG levels tend to decrease rapidly in the postnatal period in both groups. It was shown that patients whose serum IgG levels higher needed less ventilatory support, had less amount of NICU admission period and higher survival rate. It was observed that patients who needed supportive immunoglobulins treatment had more frequent complications. Serum IgG levels were found higher in babies whose mother had situations that stimulates fetal inflammation such as preeclampsia, hypertension and oligohydroamnios. Key Words: Immunoglobulins, neonatal, preterm, newborn, complications of prematurity