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Inflammatory Indices in Preterm Infants with Hemodynamically Significant Patent Ductus Arteriosus: Early Postnatal
Demet Türkeli1, Ilkay Er2, Hikmet Kıztanır3
1Department of Pediatrics, Faculty of Medicine, Recep Tayyip Erdogan University, 53200 Rize, Turkey.
Insights
Inflammatory markers from complete blood counts (CBC) show distinct early patterns in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA). Changes in the pan-immune inflammation value (PIV) may indicate treatment response but require further study.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Immunology
Background:
- Inflammation may drive persistent ductal patency in preterm infants with hsPDA.
- Early postnatal inflammatory profiles are not well understood in this population.
Purpose of the Study:
- To evaluate temporal patterns of CBC-derived inflammatory indices in preterm infants with hsPDA.
- To assess the relationship between these indices and treatment response to pharmacologic closure.
Main Methods:
- Retrospective study of preterm infants (<34 weeks' gestation) treated for hsPDA.
- Analysis of CBC-derived inflammatory indices (NLR, MLR, PLR, SII, SIRI, PIV, IG) on postnatal days 1, 3, and 7.
- Comparison of indices and their changes (ΔPIV) based on pharmacologic treatment response.
Main Results:
- NLR, PLR peaked on day 3; MLR remained elevated; PIV increased over the first week.
- Only ΔPIV differed significantly between treatment responders and non-responders (greater increase in non-responders).
- ΔPIV showed limited discrimination for non-response (AUC=0.646).
Conclusions:
- CBC-derived inflammatory indices exhibit unique early postnatal patterns in hsPDA.
- ΔPIV is a potential hypothesis-generating marker for treatment response, not a standalone predictor.
- Further validation of ΔPIV is necessary.
Abstract:
Background: Inflammatory mechanisms may contribute to persistent ductal patency in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA). This study evaluated early postnatal temporal patterns of complete blood count (CBC)-derived inflammatory indices in relation to ductal status and pharmacologic treatment response. Methods: This retrospective single-center study included preterm infants born at <34 weeks' gestation who received pharmacologic treatment for hsPDA. Hematologic parameters and CBC-derived inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune inflammation value (PIV), and immature granulocyte (IG) parameters, were assessed on postnatal days 1, 3, and 7. Results: The final cohort included 71 preterm infants with hsPDA. Over the first postnatal week, NLR and PLR peaked on day 3, MLR remained elevated, and PIV increased toward day 7. SII and SIRI showed significant temporal variation, whereas IG parameters did not. Among longitudinal changes, only ΔPIV, calculated as day 3 minus day 7 values, differed by treatment response, with a greater increase in PIV observed among non-responders. ΔPIV yielded limited discrimination for non-response (AUC = 0.646; sensitivity, 92%; specificity, 37%; cut-off, ≤110.4). Birth weight and gestational age were positively correlated with several hematologic parameters and inflammatory indices, whereas ductal status showed inverse associations with IG% on day 1 and with monocyte count and MLR on day 3. After adjustment for maturational factors and treatment type, the ΔPIV-response association was attenuated, without improved discrimination. Conclusions: CBC-derived inflammatory indices demonstrated distinct early postnatal patterns in infants with hsPDA. ΔPIV may serve as a hypothesis-generating longitudinal marker of treatment response rather than a stand-alone predictor and warrants further validation.