Goryachko Alexander Nikolaevich, Sukalo Alexander Vasilyevich, Gocht Anastasiya AlexandrovnaBelarusian State Medical University, Belarus
Title: Prognostic significance of hematological parameters in newborns with congenital pneumonia
Introduction: Nowadays expensive high-tech methods are used for the differential diagnosis of lung diseases, decreasing the informativeness of standard studies. The use of ROC analysis of hematological parameters will allow to determine the predictors of congenital pneumonia and its complications, which will increase their diagnostic and prognostic significance.
The aim of the study. To determine the prognostic significance of hematological parameters in newborns with congenital pneumonia.
Materials and methods of research. A comprehensive examination of 337 newborns who were treated and cared for at the State Research Center "Mother and Child" in the period from 2017 to 2019 was conducted.
All newborns were divided into five groups. The first study group included 53 full-term newborns with congenital pneumonia, born at 39.0 (39.0; 40.0) weeks gestation, with a body weight of 3370.0 (2980.0; 3650.0) g; the second – 55 infants with low birth weight, respiratory disorders syndrome and congenital pneumonia, born at 35.0 (33.0; 36.0) weeks gestation with a body weight of 2080.0 (1870.0; 2420.0) g; the third – 113 premature newborns with very low and extremely low birth weight, respiratory disorders syndrome and congenital pneumonia born at 28.0 (27.0; 30.0) gestation weeks with a body weight of 990.0 (880.0; 1350.0) g. The control group consisted of 63 healthy full–term newborns born at 39.0 (39.0; 40.0) weeks gestation with a body weight of 3370.0 (3250.0; 3620.0) g, the comparison group consisted of 53 conditionally healthy premature infants with low birth weight and respiratory disorders syndrome, born at 35.0 (35.0; 36.0) weeks gestation with a body weight of 2300.0 (2140.0; 2400.0) g.
Statistical data processing was performed using the Statistica 10 software package and Microsoft Excel. The differences were considered statistically significant at p<0.05. The prognostic significance was assessed using binary logistic regression and ROC curve analysis.
Results: The analysis of 79 indicators of acid-base state, coagulogram, general and biochemical blood tests in 116 full-term newborns was carried out. To determine the significance of hematological indicators, the quantitative values were translated into qualitative ones. When comparing full-term newborns with pneumonia in 12 (22.6%) cases versus 1 (1.6%) in the control group, leukocytosis was observed (in 1-2 days of life >30x109/l, in 5-7 days of life >20x109/l) (?2=12.8, p<0.001), in 8 (15.1%) cases – thrombocytopenia (<150x109/l) (F=0.09, p=0.001) and in 5 (9.4%) observations (F=0.05, p=0.018) – an increased value of C-reactive protein (CRP) (>6 g/l) (taking into account the upper limit of the normative values of CRP for this method and the type of analyzer) with no registration of thrombocytopenia and a high level of CRP in newborns of the control group. 79 blood parameters were analyzed in 221 premature newborns with different body weights. Statistically significant among the indicators of the general blood test associated with congenital pneumonia were changes in the content of leukocytes (leukopenia <5x109/l or leukocytosis on 1-2 days of life >30x109/ l, on 5-7 days of life >20x109/l, after 7 days of life >17x109/l), high neutrophil index (>0.2) and thrombocytopenia (<150x109/l). The results of the study are confirmed by the data of the ROC analysis: universal coefficient equal to ?2=16.46, p<0.001, sensitivity – 73.8%, specificity – 86.8% and the area under the ROC curve AUC=0.85±0.046 (0.80-0.90), p<0.001. Hypoproteinemia (<40 g/l), hypoalbuminemia (<25 g/l) with high levels of C-reactive protein (>6 mg/l) and lactate (>2 mmol/l), which are associated with the development and course of congenital pneumonia in the neonatal period, were the most significant among the indicators of acid-base status and biochemical blood analysis in premature newborns with different body weight and congenital pneumonia. The results of the study are confirmed by the data of the ROC analysis: a universal coefficient equal to ?2=46.63, p<0.001, sensitivity – 75.0%, specificity – 90.6% and the area under the ROC curve AUC=0.90±0.046 (0.86-0.94), p<0.001. The prognostic values of coagulogram parameters associated with the development of hemorrhagic syndrome in premature newborns with congenital pneumonia were determined: activated partial thromboplastin time (>55.5 s), R coefficient (>2.1), prothrombin time (>21.8 s), Quick prothrombin index (<47.2%), international normalized ratio (>1.9), thrombin time (>27.2 s), fibrinogen (<1.9 g/l), D-dimer (>3.5 mcg/ml). The results of the study are confirmed by the data of the ROC analysis: a universal coefficient equal to ?2=24.19, p= 0.004, sensitivity – 92.9%, specificity – 41.8% and the area under the ROC curve AUC=0.69±0.39 (0.62-0.76), p<0.001.
Goryachko Alexander Nikolaevich: He graduated from the pediatric faculty of the Minsk State Medical Institute in 1989. From 1989 to 1991, he was a district pediatrician. Primary specialization in neonatology. From 1991 to 1992, he was a neonatologist of the maternity physiological department of the maternity hospital of the Soligorsk TMO. From 1992 to 1994, he completed a clinical residency in neonatology. Primary specialization in anaesthesiology and resuscitation. From 1994 to 1995, he was an anesthesiologist-resuscitator of the department of resuscitation and intensive care for new-borns. From 1995 to 2000, he was a researcher at the Research Institute for the Protection of Motherhood and Childhood. In January 1999, he defended his PhD thesis on the topic: “The state of hemodynamic and heart rate in new-borns from ecologically unfavorable regions of Belarus”. From 2000 to 2011. assistant of the 1st department of children’s diseases. In 2012, he was awarded the academic title of associate professor in the specialty “Clinical Medicine”. From 2012 to the present-associate professor of the 1st department of children’s diseases. The highest qualification category in pediatrics. Author of more than 140 publications. More than 20 years of teaching experience. The number of publications in the RSCI is 15.
Sukalo Alexander Vasilyevich: Academician of the National Academy of Sciences of Belarus, Corresponding Member of the National Academy of Sciences of Belarus, Honored Scientist of the Republic of Belarus, PhD, DSc, Professor, became the Head of the 1st Department of Childhood Diseases in 1994 A.V. Sukalo defended his PhD thesis “Clinical and immunological characteristics and prevention of recurrence of glomerulonephritis in children” in 1982, and he successfully defended his doctoral dissertation “Primary glomerulonephritis in children of Belarus in modern environmental conditions” in 1995. A.V. Sukalo introduced the method of nephrobiopsy in pediatric nephrology in Belarus, he is one of the organizers of the Pediatric Hemodialysis Center, scientific director of the Republican Center for Pediatric Nephrology and Renal Replacement Therapy. Under the leadership of A.V. Sukalo, the scientific projects “Healing and diagnostic technologies”, “Mother and child”, “Expertise and medical rehabilitation”, of the Fund for Fundamental Research of the National Academy of Sciences of Belarus are being carried out. Every year, under the leadership of A.V. Sukalo hosts international scientific and practical conferences on pediatric nephrology, in 2006 - the European School of Pediatric Nephrology (ESPN). A.V. Sukalo is a member of the board of the Creative Association of Pediatric Nephrologists (Russia), chief freelance pediatric nephrologist of the Ministry of Health of Belarus, head of the center for pediatric nephrology and renal replacement therapy, expert at the center of expertise and testing, member of the editorial boards of the journals “Healthcare”, “Nephrology”, “Medical Panorama”, “Reproductive health”, etc. Since 2015, A.V. Sukalo is an academician of the National Academy of Sciences of Belarus.