Journals / Perinatoloji Dergisi / 2020 / Cilt: 28 - Sayı: 3
The relationship between the low Apgar scores of the newborns and hematologic parameters which are inflammatory markers
- Journal
- Perinatoloji Dergisi
- Pages
- 157–164
- DOI
- —
Abstract
Objective: To investigate the relationship between the 5-minute Apgar scores of the newborns checked in the cases induced due to prolonged pregnancy and neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), and to investigate the contributions of these parameters as prognostic markers in the low Apgar scores. Methods: A total of 169 primigravida cases for which delivery by induction was decided due to prolonged pregnancy after they completed 41 weeks of gestation between 2017 and 2018 were included in the study. The detailed previous histories of all cases were obtained at admission and they underwent cervicovaginal examination, obstetric ultrasonography for the assessment of fetal biometry and amniotic fluid, and complete blood count including hemoglobin level, total white blood cell count, differential leukocyte number and platelet count. NLR and PLR were calculated as the ratio of neutrophil number to lymphocyte number and the ratio of platelet number to lymphocyte number, respectively. The Apgar scores in the newborn assessment were determined according to the usual criteria 1 and 5 minutes after the birth. The independent samples t-test, Mann-Whitney U test and chi-square test were used for the analysis of the data. Results: The mean NLR and PLR values of the cases were calculated 4.8±2.8 and 148.8±74.9, respectively. While 108 (64%) patients delivered vaginally, 61 (36%) patients delivered by cesarean section. The Apgar score was >7 in 142 (84%) patients and <7 in 27 (16%) patients. NLR and PLR values were significantly higher in the group with Apgar score <7 than the group with Apgar score ≥7 (p<0.05). Conclusion: The elevations in NLR and PLR is the usual part of a health pregnancy; however, excessively elevated inflammation has been associated with poor prenatal and developmental outcomes in various populations. In conclusion, these markers can be used as the parameters helping clinicians to predict poor obstetric outcomes.
Özet
Amaç: Uzam›fl gebelik nedeni ile indüklenen olgularda bak›lan yenido¤ an 5. dakika Apgar skoru ile nötrofillerin lenfositlere oran› (NLR) ve trombositlerin lenfositlere oran› (PLR) aras›ndaki iliflkiyi araflt›rmak ve bu parametrelerin düflük Apgar skorlar›nda prognostik belirteç olarak katk›lar›n› incelemektir. Yöntem: 2017–2018 y›llar› aras›nda 41. gebelik haftas›n› tamamlayarak uzam›fl gebelik nedeniyle indüksiyon ile do¤um karar› al›- nan 169 primigravid olgu çal›flmaya dahil edildi. Tüm olgular kabul an›nda ayr›nt›l› öykü alma, servikovajinal muayene, fetal biyometri ve amniyotik s›v› de¤erlendirmesi için obstetrik ultrason ve hemoglobin düzeyi, toplam beyaz küre say›m›, diferansiyel lökosit say›s› ve trombosit say›m› dahil tam kan say›mlar›na tabi tutuldu. NLR ve PLR s›ras›yla nötrofil say›s›n›n lenfosit say›s›na oran› ve trombosit say›s›n›n lenfosit say›s›na oran› olarak hesapland›. Yenido¤ an›n de¤erlendirilmesinde Apgar skorlar› do¤umdan bir ve befl dakika sonra ola¤an kriterlere göre tayin edildi. Verilerin analizinde ba¤›ms›z örneklem t testi, Mann-Whitney U ve ki-kare testleri kullan›ld›. Bulgular: Hastalar›n ortalama NLR de¤erleri 4.8±2.8, PLR de¤erleri 148.8±74.9 olarak saptand›, 108 (%64) hasta vajinal yolla do¤um yaparken, 61 (%36) hastada sezaryen ile do¤um gerçekleflti. 142 (%84) hastada Apgar skoru >7 iken, 27 (%16) hastada <7 olarak belirlendi. Apgar <7 olan grupta NLR ve PLR de¤erleri Apgar ≥7 olan gruptan anlaml› (p<0.05) olarak daha yüksekti. Sonuç: NLR ve PLR’deki yükselmeler, sa¤l›kl› gebeli¤in ola¤an bir parças›d›r ancak afl›r› artm›fl inflamasyon, çok çeflitli popülasyonlarda olumsuz do¤um ve geliflimsel sonuçlarla iliflkili bulunmufltur. Sonuç olarak, bu belirteçler kötü obstetrik sonuçlar› öngörmede klinisyenlere yard›mc› olan parametreler olarak kullan›- labilir.