Surgery, sepsis, and nonspecific immune function in neonates

Area of Science:

• Neonatal surgery
• Immunology
• Pediatric critical care

Background:

• Neonatal surgical patients, particularly those with low birth weight, face increased risks of post-operative complications.
• Sepsis is a significant concern in neonates undergoing major surgical trauma.
• Understanding immune system activity is crucial for managing these high-risk infants.

Purpose of the Study:

• To investigate the immune system's role in post-operative sepsis susceptibility in neonatal surgical patients.
• To compare immune activity pre- and post-operatively in low birth weight versus mature neonates.
• To identify specific immune deficits contributing to sepsis risk.

Main Methods:

• An audit of 143 neonatal surgical operations was conducted.
• A novel chemiluminescence micro-method was developed to assess immune activity.
• Plasma opsonising activity, immunoglobulin levels, complement factors, and polymorph activity were measured.

Main Results:

• Low birth weight infants exhibited significantly impaired plasma opsonising activity, reduced immunoglobulin and complement levels, and lower polymorph activity post-operatively.
• Immune activity was further diminished in low birth weight infants compared to mature neonates.
• These deficits were particularly pronounced following major surgical trauma.

Conclusions:

• Low birth weight infants are at heightened risk for post-operative sepsis due to inherent and surgery-induced immune system deficiencies.
• Impaired non-specific immune system activity, including opsonisation and polymorph function, underlies this increased susceptibility.
• Targeted immune support strategies may be necessary for low birth weight neonates undergoing surgery.