Predictive Value Of Peripheral Blood NLR In Neonatal Sepsis In Patients With PPROM

ObjectiveTo analyze whether there are markers related to neonatal sepsis in maternal peripheral blood with preterm rupture of membranes(PPROM),and discuss the value and cut-off value of these markers,so as to guide neonatal intervention as early as possible and to obtain better neonatal outcomes.MethodsThis retrospective cohort study was conducted among 269 pregnant women who were hospitalized at Department of Obstetrics and Gynecology,Shandong Provincial Hospital Affiliated to Shandong University with the diagnosis of PPROM between January,2016 and August,2020.Cases were divided into three main groups:Group 1,PPROM diagnosed at 24th-27+6th weeks of gestation,Group 2,PPROM diagnosed at 28th-31+6th weeks of gestation and Group 3,PPROM diagnosed at 32th-34+6th weeks of gestation.Meanwhile,main study groups were divided into two subgroups:Subgroup A:neonates with sepsis and Subgroup B:neonates without sepsis.Thereafter,main study groups were divided into else three subgroups according latency:Subgroup a:2 days,Subgroup b:3-6 days and Subgroup c:≥7 days.Subgroups were compared in three main study groups in terms of demographic features,clinical characteristics,laboratory test results,to clarify the relationship between relevant indicators and neonatal sepsis.Furthermore,cut-off values of the indicator for the prediction of neonatal sepsis were determined for three main groups.Receiver operating characteristic(ROC)curves were used to assess the performance of the indicator value in predicting neonatal sepsis.And the relationship was analyzed between neonatal sepsis and the gestational age of diagnosis,the latency in the three main study groups.Results1.In comparison of demographic features,clinical characteristics,statistically significant differences were observed for maternal age,BMI,gestational age at diagnosis,gestational age at delivery,neonatal birth weight,Ith minute Apgar≤5,5th minute Apgar≤7,neonates requiring resuscitation between subgroups in group2(P<0.05),gestational age at delivery between subgroups in group3(P<0.05)and no difference in groupl.2.Among the three main study groups,all the value of NLR had statistically significant differences(P<0.05),and NLR of subgroup A was higher than that of subgroup B.According to the ROC,the cut-off values of NLR for predicting neonatal sepsis among different subgroups were:group1:4.87(sensitivity:69.23%,specificity:75.00%),group2:5.31(sensitivity:77.14%,specificity:57.78%),group 3:4.94(sensitivity:85.71%,specificity:65.22%).3.The proportion of neonates diagnosed with sepsis had statistically significant differences(P<0.001)among three main study groups,the earlier the gestational age at diagnosis,the higher the risk of neonatal sepsis.4.The mode of delivery had statistically significant differences(P<0.001)among three main study groups,the earlier the gestational age at diagnosis,the higher the rate of caesarean section.5.In all patients,compared with neonates without sepsis,neonates with sepsis had higher rate at 1th minute Apgar≤5,5th minute Apgar≤7,neonates requiring resuscitation(P<0.001).6.Compared within a,b,c subgroups of all three main study groups,prolongation of latency could not increase the proportion of neonates with sepsis.ConclusionsNLR may be used as an indicator for the prediction of neonatal sepsis in PPROM.Neonates with sepsis have lower Apgar scare and higher rate requiring resuscitation.The earlier the gestational age at diagnosis,the higher the risk of neonatal sepsis and rate of caesarean section,and prolongation of latency do not increase the rate of neonatal sepsis.