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Immune function in paediatric trauma patients: a prospective explorative cohort study
Lotte M C Jacobs1, Michiel Vaneker2,3, Demi van Dalen1
1Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands.
Insights
Trauma in children triggers rapid immune changes, with severe injuries leading to immunosuppression that increases infection risk. This immunosuppression may be partially reversed by interferon-gamma (IFN-γ).
Area of Science:
- Pediatric critical care medicine
- Immunology
- Trauma surgery
Background:
- Trauma is a significant risk factor for nosocomial infections in children.
- The immunological effects of trauma and their link to injury severity in pediatric patients are not well understood.
- Associations between injury severity and immunosuppression in pediatric trauma patients require investigation.
Purpose of the Study:
- To characterize the early immunological effects of trauma and injury severity in pediatric patients.
- To assess differences in immune profiles between polytrauma patients who develop nosocomial infections and those with uncomplicated recovery.
- To explore potential therapeutic interventions for trauma-induced immunosuppression.
Main Methods:
- Prospective cohort study of children (4-16 years) including controls, monotrauma, and polytrauma patients.
- Immune function assessed via blood samples at the trauma scene, emergency room, and post-injury day 1.
- Evaluated immune cell counts, functionality, plasma cytokines, damage-associated molecular patterns (DAMPs), and ex vivo cytokine production.
Main Results:
- Elevated inflammatory biomarkers and immunosuppression were observed early after trauma, particularly in polytrauma patients.
- Immune trajectories differed between monotrauma and polytrauma groups, with polytrauma patients showing a more severe response.
- Polytrauma patients who developed nosocomial infections exhibited profound immunosuppression, partially reversible ex vivo with interferon-gamma (IFN-γ).
Conclusions:
- Paediatric traumatic injury induces rapid immune responses, with polytrauma leading to significant immunosuppression and increased infection risk.
- Early immune monitoring can identify high-risk pediatric trauma patients who may benefit from immunomodulatory therapies like IFN-γ.
- Findings suggest potential for targeted immunomodulation to mitigate infection risk in pediatric trauma patients, though further research with larger cohorts is warranted.
Background:
Trauma is an important risk factor for the development of nosocomial infections. Immunological consequences of trauma in paediatric patients remains scarcely explored and associations between injury severity and immunosuppression, a decreased functionality of the immune system, have not yet been investigated in this population. Therefore, the aim of this study was to characterise the early effects of trauma and trauma severity on paediatric immune function, and to assess whether immune profiles differed between polytrauma patients who developed nosocomial infections and those who experienced an uncomplicated recovery.
Methods:
This prospective explorative cohort study was conducted at Radboud University Medical Center between January 2024 and June 2025. Three groups were included: controls (n=10), monotrauma patients (single fracture requiring acute surgery, n=9), and polytrauma patients (Injury Severity Score ≥ 16, n=10) aged 4-16 years. Immune function was assessed using blood samples at three timepoints: at the trauma scene (HEMS), at the emergency room (ER), and on post-injury day 1 (PID1). Immune outcomes included immune cell counts and functionality, plasma concentrations of damage-associated molecular patterns (DAMPs) and cytokines, and ex vivo cytokine production capacity upon whole blood stimulation with an endotoxin.
Results:
Inflammatory biomarkers were elevated already at the trauma scene, followed by compensatory mechanisms. Immunosuppression was already detected in the ER. Immune trajectories differed between poly- and monotrauma patients, with the latter showing a milder response. Polytrauma patients who developed nosocomial infections exhibited more profound immunosuppression. Immunosuppression was at least partially reversible ex vivo by co-stimulation with interferon-γ (IFN-γ).
Conclusions:
Paediatric traumatic injury rapidly elicits a robust immune response, particularly in cases of polytrauma, alongside compensatory mechanisms. Children who developed nosocomial infections showed more pronounced immunosuppression, which might be partially reversed with IFN-γ. Given the small sample size, these exploratory findings should be interpreted cautiously. Early immune monitoring may help identify paediatric trauma patients at increased infection risk who might benefit from immunomodulation.
Trial Registration:
Medical Ethics Review Committee 'METC Oost-Nederland', file number 2023-16883.
