ABSTRACT. Defects in polymorphonuclear neutrophil (PMN) adherence and chemotaxis in neonates are thought to be an important cause of their increased susceptibility to overwhelming bacterial infection. Few studies of these functions have been carried out in stressed neonates who are at even greater risk of infection. PMN adherence and chemotaxis were examined in 33 stressed neonates with acute lower respiratory illness, 13 healthy neonates, and 43 healthy adults using whole blood PMN adherence and chemotaxis assays. PMN chemotaxis was significantly decreased in stressed neonates (locomotion index of 38.4 + 9.7 pm) compared with that of healthy neonates (48.9 + 12.8 pm, p < 0.01) or adults (61.6 9 11.9 pm,p < 0.001).PMN chemotaxis was studied during illness and recovery in 13 of the 33 stressed neonates and showed significant improvement during recovery (41.6 2 9.9 and 53.2 + 11.9 pm, respectively, p = 0.012). PMN adherence was de- Bacterial infections are a major cause of morbidity and mortality in newborn infants primarily because of immaturity of their host defense mechanisms (1, 2). Neutrophils (PMNs) are the major cellular elements which defend against bacterial invasion. They respond to infection by adhering to vascular endothehum, moving toward the site of infection along a chemotactic gradient (chemotaxis) and killing ingested bacteria. The functional capacity of neonatal PMNs have been carefully studied and although results are not entirely consistent, PMN adherence (3-5) and chemotaxis (6-8) appear to be depressed in healthy neonates compared with that of adults while phagocytosis and microbial killing (9-12) are intact. In studies of neonates with underlying illness or stress, PMN phagocytosis has been found to be normal ( I 1-1 5) while microbial killing has been found to Received Junc 17. 1985: accepted November 26, 1985 be decreased ( 11-1 3, 15, 16). There have been few studies of PMN adherence and chemotaxis in stressed neonates (17). Since further impairment in these functions could help explain the increased susceptibility of stressed neonates to overwhelming bacterial infection, we prospectively studied PMN adherence and chemotaxis in healthy newborn infants and those with respiratory distress syndrome, pneumonia, and other cardiorespiratory illnesses.
MATERIALS AND METHODSSubjects. Blood was obtained from 33 stressed neonates with a median chronological age of 3 days (range 1-88 days) and median gestational age of 36 wk (range 25-43 wk), 13 healthy neonates with a median chronological age of 6 days (range 3-88 days) and median gestational age of 36 wk (range 27-42 wk) and 43 healthy adults.