An Unknown Risk Factor for Sepsis in Very Low Birth Weight Preterms: ABO Blood Groups (BGaPS Study)

Evaluation of the relationship between day or night birth time and morbidities and mortality in premature infants less than 32 weeks in a Turkish NICU

Staffing levels, fatigue, and intervention timing may vary based on working hours and potentially influence the clinical outcomes of newborns. It remains unclear how the birth time of premature infants throughout the day affects their clinical outcome. This study aimed to compare the clinical outcomes of premature infants born during and after work hours. In this single-center retrospective cohort study, infants born at <32 weeks of age were categorized into two groups based on birth time. The first group included infants born during daytime working hours on weekdays, whereas the second group included infants born during nighttime working hours on weekdays, weekends, and public holidays. Both groups were compared in terms of clinical outcomes. Data from 572 patients born at <32 weeks of age were analyzed, with 137 (24%) infants in the on-hours group and 435 (76%) in the off-hours group. No significant differences were observed between the groups in terms of gestational age (GA) (27.4 ± 2.8 weeks vs. 27.7 ± 2.7 weeks), birth weight (BW) (1132 ± 459 g vs. 1064 ± 450 g), and gender distribution (53.2% vs. 55.4% male) (P > .05). There were no significant differences in other clinical outcomes, morbidities, or mortality rates between the groups (P > .05). Despite potential fluctuations in neonatal intensive care unit (NICU) staffing levels during on- and off-duty hours, the morbidity and mortality of premature infants aged <32 weeks were not affected in our unit. Each NICU should assess whether delivery time influences clinical outcomes, based on unique care conditions. The change in clinical outcomes depending on the time of birth may be particularly important in low- and middle-income countries (LMIC). Negative results may be an indication that the staff is under excessive workload. In addition, by providing a solution to the cause of the detected problem, both clinical outcomes may be improved and patient care costs due to morbidity may be reduced. Our results may be particularly important for studies to be conducted on this subject in LMIC.

Maternal-Newborn ABO Blood Groups and Risk of Bacterial Infection in Newborns

Importance

Newborn immunity largely relies on maternal-fetal transfer of antibodies in utero. Incongruency in ABO blood groups between a mother and newborn may be associated with protection against serious infections, but data specific to newborn bacterial infections are lacking.

Objective

To ascertain the association between maternal-newborn ABO blood group incongruence and lower risk of bacterial infection in newborns.

Design, Setting, and Participants

This cohort study used linked patient-level datasets for all singleton live births between January 1, 2014, and December 31, 2020, in hospitals and health centers in Ontario, Canada. The cohort comprised maternal-newborn pairs with known ABO blood groups. Data analysis was conducted between February and May 2024.

Exposure

Maternal-newborn ABO blood group incongruence vs congruence.

Main Outcomes and Measures

The primary outcome was a bacterial infection arising in newborns within 30 days of birth. Bacterial infection was cultured from either blood, cerebrospinal fluid, urine, or lung specimen. Secondary outcomes were a bacterial infection with 7 days and 90 days of birth. Modified Poisson regression generated adjusted relative risks (ARRs) and 95% CIs, adjusted for neonatal sex and preterm birth.

Results

A total of 138 207 maternal-newborn pairs (maternal mean [SD] age, 31.8 [5.1] years among those with ABO blood group incongruency and 31.5 [5.1] years among those with ABO blood group congruency; newborn mean [SD] gestational age, 38.5 [2.3] weeks among those with incongruency and 38.4 [2.5] weeks among those with congruency; 19 475 males [51.3%] with incongruency and 52 041 males [51.9%] with congruency) were analyzed. Of these pairs, 37 953 (27.5%) had ABO blood group incongruency and 100 254 (72.5%) had ABO blood group congruency. Within 30 days of birth, 328 (8.6 per 1000) newborns in the incongruent group and 1029 (10.3 per 1000) newborns in the congruent group experienced a bacterial infection, corresponding to an ARR of 0.91 (95% CI, 0.81-1.03). The ARRs for bacterial infection within 7 days and 90 days of birth were 0.89 (95% CI, 0.73-1.09) and 0.86 (95% CI, 0.78-0.94), respectively.

Conclusions and Relevance

This cohort study found no association between maternal-newborn ABO blood group incongruence and risk of bacterial infection in newborns within 30 and 7 days of birth. However, incongruence was associated with a decreased risk of bacterial infection within 90 days of birth.

Evaluation of systemic inflammatory indices in the diagnosis of early onset neonatal sepsis in very low birth weight infants

BACKGROUND

Previously, not six systemic inflammatory indices were evaluated in the diagnosis of early onset sepsis (EOS) in very low birth weight (VLBW, <1500g) premature infants.

OBJECTIVES

We evaluated the effectiveness of systemic inflammatory indices in the diagnosis of EOS in VLBW infants.

METHODS

Premature infants with birth weight <1500 g were included in the study. Six systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and systemic inflammation response index (SIRI) were compared in patients with EOS (treatment group) and without EOS (control group).

RESULTS

Of 917 infants enrolled, 204 infants were in the EOS group and 713 infants comprised the control group. NLR, MLR and SIRI values were significantly higher in the EOS group than in the control group (p < 0.001). The AUC value of SIRI for the predictivity of EOS was 0.803.

CONCLUSIONS

The SIRI can be used together with other parameters as both an easily accessible and the reliable systemic inflammatory indices in the diagnosis of EOS in VLBW preterm infants.

Relationship between thyroid function tests and small for gestational age in preterm newborns

Purpose: The aim of this study was to evaluate the relationship between thyroid hormone levels and clinical outcomes in preterm, small for gestational age (SGA) infants. Materials and Methods: The premature newborns (gestational age of ≤30 weeks) were divided into two groups as SGA and non-SGA. Thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels, the frequency of congenital hypothyroidism (CH), demographic and clinical characteristics, morbidity and mortality rate were compared between the groups. Results: A total of 430 premature newborns, 72 in the SGA group and 358 in the non-SGA group were included. The frequency of CH, morbidity, demographic and clinical characteristics were similar between two groups. The mortality rate was higher in SGA (36.1%) than in non-SGA group (13.6%). Serum fT4 level was lower in SGA group (1.04±0.30 ng/dl) compared to the non-SGA group (1.24±0.33 ng/dl). The serum TSH level was higher in SGA group (9.91 ± 5.6 uIU/L) than in non-SGA group (6.6 ± 5.2 uIU/L). Conclusion: The frequency of thyroid dysfunction was higher in preterm SGA infants compared to non-SGA, which was due to transiently high TSH and low fT4 concentrations. Therefore, thyroid function tests should be monitored periodically in preterm and SGA infants.