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FEATURES OF CHANGES IN THE HEMOGRAM FROM
INTRAUTERINE INFECTION IN NEWBORNS
Inakova B.B.
Nuritdinova G.T.
Yuldashev K.S.
Otabekova M.U.
Andijan State Medical Institute
https://doi.org/10.5281/zenodo.15661100
Abstract
: Hemolytic disease of the fetus and newborn is a condition in
which the fetus's red blood cells are destroyed due to blood group
incompatibility, primarily involving the Rh or ABO blood groups. Rh
incompatibility usually affects subsequent pregnancies because maternal
sensitization occurs during the first pregnancy, leading to more serious
complications such as intrauterine hydrops fetalis in subsequent pregnancies.
Keywords:
Ureaplasma urealyticum, bronchopulmonary dysplasia,
intrauterine infection, prematurity metabolic bone disease, preterm infants,
retinopathy of prematurity.
neonate sepsis.
Аннотация:
Гемолитическая болезнь плода и новорожденного — это
состояние, при котором эритроциты плода разрушаются из-за
несовместимости групп крови, в первую очередь по резус-фактору или
группам крови ABO. Резус-несовместимость обычно влияет на
последующие
беременности,
поскольку
сенсибилизация
матери
происходит во время первой беременности, что приводит к более
серьезным осложнениям, таким как внутриматочная водянка плода при
последующих беременностях.
Ключевые слова:
Бронхолегочная дисплазия, внутриутробная
инфекция, метаболическое заболевание костей у недоношенных,
недоношенные дети, ретинопатия недоношенных, сепсис новорожденных.
Introduction:
Anti-D immune globulin prevents sensitization of women
with a Rh-negative blood type. Since its introduction, a significant decline of
80% to 90% in the incidence of Rh-hemolytic disease has been observed, along
with a two-thirds decline in the mortality rate in nationwide
surveillance. Administration of anti-D immune globulin to Rh-negative mothers
at the time of antigen exposure, eg, the birth of an Rh-positive child, blocks the
primary immune response to the foreign cells. Therefore, maternal antibodies to
Rh-positive cells are not produced in subsequent pregnancies, and hemolytic
disease of the neonate is averted. Rh all immunization continues to be a
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significant issue in areas with limited anti-D immune globulin access or
availability.
Research and result:
Currently, one of the most difficult difficulties
confronting clinicians is the early detection of neonatal sepsis. If the diagnosis of
neonatal sepsis is delayed and treatment is ineffective, it can lead to systemic
problems and a high fatality risk. Although blood culture is considered the gold
standard diagnostic technique for newborn sepsis, it has several limitations.
These are inaccessible in the majority of impoverished nations, have
technological issues, and take more than three days to see at least the first
preliminary result, with a positivity yield of 30%-70%. As a result, the left
percent of neonates with sepsis could not be diagnosed by blood culture; the
diagnosis of neonatal sepsis is based on clinical assessment, and management is
also based on empirical treatment protocol, which usually results in
unnecessary hospitalization, increased irrational use of antibiotics, and
additional costs for the family Although platelet, lymphocyte, and neutrophil
counts are analyzed in a single mode, they may serve as clinical markers of
underlying infections such as sepsis and associated immune dysfunctions.
In recent years, the platelet to lymphocyte ratio (PLR), neutrophil to
lymphocyte ratio (NLR), immature to total neutrophil ratio, and immature to
mature neutrophil ratio have been identified as prospective markers of systemic
inflammation and infectious illness prognosis.
Because newborns' defense barrier function and immune system
development are still insufficient, and the condition of neonatal sepsis advances
rapidly, early identification and accurate treatment are critical to lowering
death. The NLR and PLR markers derived from blood analysis are now gaining
attention in the study of inflammation-related disorders. Furthermore, some
research suggests that the NLR and PLR, can be employed as prognostic
indicators for cancer and cardiovascular disease.
Adult sepsis studies revealed that NLR might be employed as a biomarker
for assessing systemic inflammation. According to one study, PLR is a good
measure for assessing patients' inflammatory response and disease activity.
Researchers and previous understandings show a progressive increase in
newborn sepsis mortality, morbidity, and economic burden around the world,
specifically in developing nations. Though not a replacement for blood culture,
hematological parameters and hemogram-derived markers have been proposed
as indicators of neonatal sepsis. Though several studies have been conducted to
test the usefulness of hematological parameters and hemogram-derived novel
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markers in neonatal sepsis diagnosis, there is not yet used very commonly in
routine practice and results vary extensively among studies. Even though
assessment and use of the hemogram-derived markers have infinite
considerations in the forecast of diagnosis of neonatal sepsis patients in a
simple, rapid, and inexpensive manner. To the best of our knowledge, no
published article is in our perspective.
All pregnant women should have testing performed, including a blood type
(ABO, RhD) and antidiv detection test (indirect antiglobulin test) that detects
IgG antibodies.
For patients with red cell sensitization, the antidiv
specificity is determined and initial risk stratification occurs. Certain blood
group antibodies such as anti-I, -P1, -Le
a
, and -Le
b
, may be ignored because the
corresponding (cognate) antigens are incompletely developed at birth, the
antibodies are typically not IgG, and clinical experience has established the
rarity of their causing HDFN.
Women with red blood cell sensitization to
clinically significant red cell antigens (such as D, E, c, K, etc) are transitioned into
a pathway of more intensive diagnostic testing and monitoring. If paternity is
assured, the paternal blood type is usually determined to predict fetal risk of
inheriting the antigen that the maternal antidiv is directed against.
For pregnancies
that have reached 16-
24 weeks, or when a
critical antidiv titer
is reached depending
on maternal history of
previously
affected
pregnancies),
fetal
anemia is monitored
using cerebral MCA
Doppler
velocity
measurements every 2
weeks
for
risk
stratification (
Correlative
studies support that
the use of the noninvasive MCA Doppler technique as a surrogate measurement
for assessing fetal anemia.
Doppler readings that are >1.5 multiples of the mean
are very sensitive, with a 12% false-positive rate, thus trending is important.
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Weekly fetal monitoring, such as ultrasound and fetal heart rate monitoring, is
also often performed.
Conclusion
: Intrauterine infections significantly impact the hematological
parameters of newborns, with the hemogram serving as a valuable diagnostic
tool in the early identification and assessment of infection severity. The present
study has revealed that key changes in the hemogram, such as leukocytosis or
leukopenia, elevated or decreased neutrophil counts, thrombocytopenia, and
anemia, are frequent and diagnostically significant findings in affected neonates.
These alterations often reflect the systemic inflammatory response and
bone marrow suppression associated with intrauterine infections. Importantly,
the dynamics of hemogram changes may also help differentiate between early-
onset and late-onset infections, aiding clinicians in determining timely and
appropriate treatment strategies.
Therefore, regular monitoring of hemogram parameters in neonates with
suspected intrauterine infections is essential for prompt diagnosis, risk
stratification, and effective clinical management. Further research is
recommended to refine the prognostic value of specific hematological markers
and integrate them into neonatal sepsis screening protocols.
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