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Published on: August 7, 2017
Monitoring Parameters During the Immediate Postnatal Transition Period and Inflammatory Markers in the First Two Days
Christina H Wolfsberger1,2,3, Andreas Hierz1, Magdalena Holter4
1Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria.
Insights
Early infection markers like C-reactive protein (CRP) and immature-to-total neutrophil ratio (IT ratio) are linked to lower oxygen levels in newborns during the critical first minutes after birth.
Area of Science:
- Neonatal physiology and adaptation
- Pediatric infectious diseases and inflammation
Background:
- The transition from fetal to neonatal life involves significant cardiorespiratory adjustments.
- Early-onset infections or inflammation in neonates can potentially impact cardiovascular adaptation.
Purpose of the Study:
- To investigate the association between early infection/inflammation markers and neonatal vital parameters within the first 15 minutes post-birth.
- To evaluate how inflammatory markers correlate with cerebral oxygen saturation (crSO2), arterial oxygen saturation (SpO2), and heart rate (HR) in neonates.
Main Methods:
- Post-hoc analysis of a prospective observational study including preterm and term neonates.
- Continuous monitoring of crSO2, SpO2, and HR during the first 15 minutes after birth.
- Measurement of inflammatory markers (CRP, leukocytes, IT ratio) within 48 hours post-birth and correlation with vital parameters.
Main Results:
- Elevated CRP and IT ratio within 24 hours post-birth showed negative correlations with crSO2 and SpO2 at 5, 10, and 15 minutes.
- The IT ratio measured between 24-48 hours also correlated negatively with crSO2 at 15 minutes.
- Leukocyte count within 24 hours correlated negatively with crSO2 at 5 minutes; no significant HR correlations were found.
Conclusions:
- Early inflammatory markers, specifically CRP and IT ratio, are associated with cerebral and systemic oxygenation during the immediate neonatal transition.
- Findings suggest a potential link between early inflammatory activation and oxygenation dynamics in neonates.
- The observational design and modest correlation strength necessitate cautious interpretation, precluding causal conclusions.
Abstract:
Objective: The fetal-to-neonatal transition is marked by profound cardio-respiratory changes. Infections emerging within the first 48 h after birth may influence early cardiovascular adaptation. We aimed to evaluate the association between early infection/inflammation markers and vital parameters in neonates during the first 15 min after birth. Methods: This is a secondary outcome parameter post-hoc analysis of data derived from a prospective observation study. Preterm and term neonates with cerebral oxygen saturation (crSO2) monitoring (INVOS 5100C) during the first 15 min after birth and available inflammatory markers (C-reactive protein [CRP], leukocytes, immature-to-total neutrophils ratio [IT ratio]) within 48 h after birth were included. Heart rate (HR) and arterial oxygen saturation (SpO2) were continuously recorded during the first 15 min. Inflammatory markers obtained at 16-24 and 24-48 h after birth were correlated with crSO2, SpO2, and HR at minute 5, 10 and 15. Results: Sixty-eight neonates were included (median (IQR) gestational age 34.0 (32.0; 35.9) weeks, birth weight 1900 (1488; 2542) grams). CRP within the first 24 h correlated negatively with crSO2 (r = -0.314; p = 0.011) and with SpO2 (r = -0.393; p = 0.001) at minute 15. IT ratio within 24 h correlated negatively with crSO2 at minute 5 (r = -0.367; p = 0.005), 10 (r = -0.273; p = 0.035), and 15 (r = -0.306; p = 0.013), and with SpO2 at minute 5 (r = -0.327; p = 0.008). IT ratio at 24-48 h correlated negatively with crSO2 at minute 15 (r = -0.384, p = 0.012). No significant correlations were observed with HR. Leukocytes within the first 24 h after birth correlated negatively with crSO2 at minute 5 (r = -0.265; p = 0.046). Conclusions: Early inflammatory markers, particularly CRP and the IT ratio, are associated with cerebral and systemic oxygenation during immediate postnatal transition. These findings suggest a potential association between early inflammatory activation and oxygenation dynamics; however, given the observational design and modest correlation strength, the results should be interpreted cautiously and do not allow conclusions regarding causality or underlying mechanisms.
