The Relationship Between Cord Blood Vitamin D,PCT,IL-6 And Early-onset Sepsis In Newborns

Neonatal sepsis refers to serious pathological changes in various systems caused by pathogens invading the blood circulation of the newborn.Non-infectious factors that cause this abnormal pathophysiological state need to be excluded.Its early clinical manifestations are non-specific,and laboratory indicators have a large influencing factor.Poor sensitivity,not ideal for early diagnosis of EOS,resulting in higher neonatal morbidity and mortality,and for newborns,venous blood collection is difficult and stressful to newborns.However,cord blood can be obtained after birth,has the advantages of non-invasive,painless and easy to save for a long time.Studies at home and abroad have shown that cord blood indicators have guiding significance for early prediction of EOS.This article investigates the correlation and clinical value of cord blood vitamin D,procalcitonin,interleukin 6 and early-onset sepsis in newborns.Objective: 1.To investigate the effect of cord blood vitamin D content on EOS in term infants.2.To detect the clinical value of early predicting EOS in term infants by detecting changes in cord blood procalcitonin and cord blood cytokine IL-6 levels.3.Determine the correlation between cord blood vitamin D level and procalcitonin and IL-6.Methods: 1.Research objects and groups: A total of 110 full-term neonates were delivered by our hospital from January 2018 to December 2018.According to the infection outcome and severity of whether there is a high risk factor for intrauterine infection,it is divided into 4 groups.Divided into 29 cases of non-infection group with high risk factors and 20 cases of infection group with high risk factors.There were 21 cases of sepsis group with high risk factors for infection.A total of 40 full-term term babies born to normal pregnant women were selected as the control group.2.Specimen collection and preparation: About 2ml of umbilical arterial blood was taken from the term infants immediately after birth.After the specimens were collected,serum was collected by centrifugation,and 25(OH)D,PCT,and IL-6 were stored at low temperature.At the same time,2-3ml of peripheral venous blood was collected within 3 days after birth for peripheral blood cells and rapid C-reactive protein determination.3.Determination of experimental indicators: The concentration of 25(OH)D in serum was determined by high performance liquid chromatography(HPLC-MS/MS).The measured values of PCT and IL-6 in serum were determined by chemiluminescence immunoassay method using magnetic particles.4.Statistical analysis: Statistical analysis was performed using SPSS22.0 software package.Measurement data are expressed as mean±standard deviation(x±s),comparison between two groups is tested by t test,comparison between multiple groups is analyzed by single factor analysis of variance;count data is expressed by rate(%),comparison between groups is tested by ?2,P < A difference of 0.05 was statistically significant.Draw the ROC curve to judge the value of the indicator.Correlation analysis used Pearson correlation analysis.Results: 1.Analysis of general clinical characteristics of term neonates in non-infected group,infected group,sepsis group and control group: There were no significant differences in gestational age,birth weight,birth pattern,birth season and sex between the four groups(P>0.05).2.Changes in cord blood 25(OH)D,PCT,and IL-6 levels in four groups of term newborns: The above three indicators were statistically significant among the sepsis group,the infected group,the non-infected group,and the control group(P<0.001).The level of 25(OH)D in the sepsis group was lower than that in the infected group,and the infection group was lower than the non-infected group,and the differences were statistically significant(P<0.05).There was no significant statistical difference between the non-infected group and the control group(P>0.05).The levels of PCT and IL-6 in the sepsis group were higher than the infected group,and the infection group was higher than the non-infected group,and the differences were statistically significant(P<0.05).There was no significant statistical difference between the non-infected group and the control group(P>0.05).3.Correlation of 25(OH)D,PCT,and IL-6 levels in all diseased groups(including infected and sepsis groups)of term newborns: all diseased groups(including infected and sepsis groups),25(OH)D is related to PCT and is negatively correlated(r =-0.333,P<0.05),25(OH)D is related to IL-6 and is negatively correlated(r =-0.415,P<0.05),This shows that the cord blood 25(OH)D level is decreasing with the increase of IL-6 and PCT content.4.Umbilical cord blood PCT,IL-6 and peripheral CRP alone detect the value of the diseased group(infected group and sepsis group): The defined positive standards are: PCT ? 0.5ng/ml;IL>23ng/ml;CRP ? 8mg/L.The sensitivity,specificity,positive predictive rate,negative predictive rate,and Yoden index of PCT were 92.7%,86.9%,80.9%,95.2% and 79.6%,respectively.The sensitivity,specificity,positive predictive rate,negative predictive rate,and Yoden index of IL-6 were 90.2%,85.5%,78.7%,93.7% and 75.8%,respectively.The sensitivity,specificity,positive predictive rate,negative predictive rate,and Yoden index of peripheral blood CRP were 82.9%,79.7%,70.8%,88.7% and 62.6%,respectively.Umbilical cord blood PCT is superior to IL-6 and CRP in the diagnosis of term neonatal infection.5.Obtain the best cutoff value by drawing the ROC curve: Use the cord blood PCT,IL-6,and peripheral blood CRP to draw the ROC curve.The area under the curve is 0.921(95%CI 0.854 ~ 0.988),0.884(95%CI 0.793 ~ 0.975),0.837(95%CI 0.728 ~ 0.946),with a range between 0.5-1,suggesting that cord blood PCT,IL-6,and peripheral blood CRP have predictive values for EOS in term infants.The area under the ROC curve of cord blood PCT is the largest,suggesting that the accuracy of predicting EOS in term infants is better.Conclusions: 1.Cord blood 25(OH)D can be used as a reference indicator for early prediction and detection of early-onset sepsis in newborns.Low cord blood 25(OH)D content is one of the risk factors for EOS in term infants.It is necessary to strengthen the health care during pregnancy to supplement sufficient vitamin D and increase the vitamin D content in cord blood,which is beneficial to prevent the occurrence of EOS in term newborns.2.Changes in cord blood PCT and IL-6 levels are of clinical value for early prediction of early-onset sepsis in term infants.Cord blood PCT and IL-6 can be used as important indicators for early detection and diagnosis of EOS in term infants,among which cord blood PCT The value of predicting EOS in term infants is better than IL-6 and CRP,indicating that cord blood PCT can be used as the best sensitive indicator for early diagnosis of EOS in term neonates.It can provide guidance for the application of effective antibiotics in time to avoid antibiotic abuse and prevent Complications occur,reducing mortality and ensuring quality of life.3.Cord blood 25(OH)D level was negatively correlated with PCT and IL-6 levels in the affected group,and cord blood 25(OH)D level was not correlated with PCT and IL-6 levels in the non-affected group.