Evaluation of new generation complete blood count parameters as an predictor of diagnosis, treatment and prognosis in preterms with sepsis, necrotizing enterocolitis and patent ductus arteriosus

Neonatal sepsis (NS) is a bacterial systemic infection that develops within the first month of life, is associated with various prenatal, natal and postnatal risks, accompanied by non-specific signs and symptoms related to infection, and has high mortality and morbidity. Necrotizing enterocolitis (NEC) is a serious gastrointestinal emergency of premature infants, characterized by intestinal edema, inflammation, ischemia, necrosis, and has a high risk of morbidity and mortality. Patent ductus arteriosus (PDA) is a common condition with high mortality and morbidity, characterized by the connection between the pulmonary artery and aorta, which is normally open during the antenatal period, remains open after birth in preterm infant. Since the clinical findings of sepsis, NEC and PDA in preterms are not specific, and there are no perfect diagnostic markers and criteria so it becomes difficult to provide definitive and early diagnosis and appropriate treatment. The new generation complete blood count (CBC) parameters has been recently used in the NICU's as a practical test that requires less blood, results quickly, for diagnostic purposes and to monitor response to treatment especially in preterm infants. The aim of this retrospective study was to evaluate the change of new generation CBC parameters with diagnosis, treatment and prognosis in preterm cases with sepsis,NEK and PDA. Demographic data, mortality, types of treatment, and the values of the new generation CBC parameters and simultaneous acute phase reactants, which are routinely taken at the time of diagnosis, before and after treatment of preterm cases with sepsis, NEC and PDA in our NICU between October 2018 and February 2021 were recorded retrospectively, The diagnostic power of each parameter, its ability to show response to treatment and predicting mortality were evaluated. The patient groups were determined as Group 1: NEC+Sepsis, Group 2:Sepsis+PDA, Group 3:NEC+Sepsis+PDA, Group 4: Isolated Sepsis, Group 5: Isolated PDA, Group 6: Control. In statistical analysis, IBM SPSS Statistics 22 programme was used. In the comparisons of the two groups, " t-test in independent groups" was used if it was suitable for normal distribution, and "Mann-Whitney U test was used if it did not fit normal distribution. The t1-t2-t3-t4 values of each group were evaluated with "variant analysis in repeated measures" in intragroup comparisons, and Friedman analysis of variance in case they did not fit the normal distribution. "One-way analysis of variance" was used in comparisons of three or more subgroups, and the "Kruskal Wallis Test" was used when it did not fit the normal distribution. "Pearson" and "Spearman" tests were used for correlation analysis. The significance level (α) was taken as 0.08 in all evaluations. In all sepsis cases; new generation erithroid CBC e parameters (NRBC, ,RPI FRC, IRF, LFR, MFR) were found to predict the diagnosis, show response to treatment and predict mortality. It was found that new generation myeloid CBC parameters (IG%, IG, HFLC) showed response to treatment, and platelet parameters (MPV, PDW) values showed response to treatment. And also it was determined that IG parameter predicted mortality. Parameters of NRBC, MacroR, RPI, FRC, IG, MPV, PDW were found to be an indicator of response to treatment in the sepsis+ PDA group. In the PDA+NEK+Sepsis group, MacroR and RET were found to be an indicator of response to treatment, in the isolated PDA group; MacroR, NLR were an indicator of response to treatment, while HFR, NLR and PLR were diagnostic indicators. In the isolated sepsis group, RET, MacroR, RPI, NLR were found to be indicators of response to treatment. In all sepsis cases, procalcitonin was positively correlated with RET and IRf parameters and negatively correlated with FRC parameters. Present study indicates that new generation CBC parameters can be used in the diagnosis, evaluation of response to treatment and prediction of mortality in preterm infants with sepsis, NEC and PDA. In the light of the data to be obtained in larger series with prospective studies in the future, new generation blood count parameters will provide early diagnosis, treatment and improvement of survival in high risk preterm infants. Key words: Preterm, sepsis, necrotizing enterocolitis, patent ductus arteriousus, new generation CBC parameters