Articles neuroimaging. We examined markers of monocyte and neutrophil function and activation (CD11b (activation), TLR-4 expression (LPS recognition), and ROI production (function)) serially over the first week of life and correlated our findings with neuroimaging.
RESULTS
Patient DemographicsFifty-one preterm infants born <32 wk gestation were included, and three infants died (normal neuroimaging n = 40; abnormal neuroimaging/ Death (RIP); n = 11). A total of 404 samples were processed. There were no differences in gender distribution, preeclampsia, prolonged rupture of membranes, maternal pyrexia, histological chorioamnionitis, surfactant treatment, gestational age, birth weight, mode of delivery, doses of antenatal steroids received, Apgar scores, cord or admission blood gas parameters, nasal continuous positive airway pressure (CPAP) hour, or duration of intubation, between preterm neonates with normal and abnormal neuroimaging ( Table 1). There was a statistically significant difference in mortality (n (%)) observed between the two groups: normal vs. abnormal neuroimaging 0 (0) vs. 3 (21) (P = 0.04).All infants had serial cranial ultrasounds, and 29 infants had a magnetic resonance imaging (MRI) brain at term corrected age. MRI was scored according to the Inder criteria (6) independently by a consultant Pediatric Radiologist. Twenty infants had completely normal imaging (white matter (WM) score = 5-6; gray matter (GM) score 3-5). Nine infants had evidence of WM abnormality (mild = 4: WM score 7-9; moderate = 3: WM score 10-12; severe = 2: WM score 13-15). One infant had both WM and GM abnormality (GM score 6-9; Tables 2 and 3). Twenty-two infants had only cranial ultrasound imaging. No abnormality was detected in 14 infants. Evidence of intraventricular hamorrhage (IVH) was detected in five infants (grade 1 = 4; grade 2 = 1). Three infants had increased echogenicity in the periventricular WM.There were no other significant differences between the study groups with respect to chronic lung disease, patent ductus arteriosus, necrotizing enterocolitis, retinopathy of prematurity, late-onset sepsis (LOS), and number of septic episodes and antibiotic days. There were no significant differences in duration of intubation, intermittent positive pressure ventilation, nasal CPAP or nasal prong oxygen hours required, duration of free flow oxygen delivery, or maximum inspired oxygen requirements during neonatal intensive care unit stay in our study population.
Neonatal Neutrophil and Monocyte ROI ProductionPreterm infants with abnormal neuroimaging produced significantly increased baseline intracellular neutrophil ROIs on day one of life compared with preterm controls (P = 0.023). There was a statistically significant increase in baseline ROI production in control preterms at 24-48 h (P = 0.047) and preterms with abnormal neuroimaging at 0-24 h of life (P =0.037) compared with adults (Figure 1a). Irrespective of neuroimaging outcome, all preterms were LPS responsive and had increased ROI production following ex vivo LPS...