Method for predicting infectious diseases in full-term neonatals

FIELD: medicine, laboratory diagnostics.

SUBSTANCE: during the 1st trimester of pregnancy (6-13 wk) in peripheral venous blood in women at risk of failed pregnancy one should detect relative content of CD16+CD56- lymphocytes and at its value being either equal or below 11% it is possible to predict the development of infectious diseases in full-term neonatals during the first 7-10 d of their lives. The innovation enables to predict the development of local form of infectious-inflammatory diseases in full-term neonatals.

EFFECT: higher accuracy of prediction.

3 ex, 1 tbl

 

The invention relates to medicine, namely to obstetrics and Perinatology, and can be used to predict infectious disease in full-term newborns by examining peripheral venous blood of women in early pregnancy.

The relevance of the proposed method. The frequency of infectious diseases in the structure of morbidity in full term newborns remains high and is, according to various authors, 6 to 53% [5, 6, 7].

The share of local forms of purulent-inflammatory diseases of the newborn is 70-80% [5, 6]. A widely observed increase in the number of neonatal infections necessitates the search for new possibilities of forecasting for the prevention of serious complications.

A known method for predicting bacterial complications in newborns by registering induced lyuminola cell chemiluminescence in whole blood in the presence of crystals, sparingly soluble salts. With increasing light-amount 2 times or more from the original forecast the development of bacterial complications [10].

The disadvantages of the method:

1. The study is performed in newborns, thereby eliminating the possibility of prevention of various infectious and inflammatory complications during the antenatal period.

2. The method is complicated greatly the th complexity in the analysis, as it requires setting at the same time, the spontaneous and induced chemiluminescence.

3. Method of cell chemiluminescence not sufficiently specific, since the content of medium-sized molecules, which determine the level of chemiluminescence, nonspecific increases in any chronic inflammatory process.

4. Do not specify the age at which it is recommended to conduct a survey.

5. No data on the accuracy of the method.

The closest technical solution is a method for predicting infectious-inflammatory diseases in premature infants by determination of IgE levels in the peripheral blood of newborns on the 3rd day of life: when IgE level above a 3.5 IU/ml predict occurrence of infectious and inflammatory pathology [11].

The disadvantages of the method:

1. Neonatal infections are estimated only in premature babies who are always present immunologic disorders [12].

2. Increased levels of IgE observed in a number of immune disorders of genetic origin (the syndrome Wiskott-Aldrich, multiple myeloma, dysgammaglobulinemia), which reduces the specificity and accuracy of the method.

3. IgE may contact the surface of responsive cells, and its level in the blood is not increased, therefore, there is a large percentage of lo is noetically results.

4. Do not specify the accuracy of the method.

These drawbacks can be eliminated in the proposed method.

The claimed technical result is achieved that in the first trimester of pregnancy (6-13 weeks) in peripheral venous blood of pregnant women with threatened miscarriage determine the relative content of CD16+CD56-lymphocytes and if the value of this index is equal to or less than 11%, predict the development of local forms of infectious-inflammatory diseases of the term infant during the first 7-10 days of life with precision 77,42%, sensitivity 100% and specificity 72,00%.

The novelty of the proposed method lies in the fact that for the first time proposed to predict the development of local forms of infectious-inflammatory diseases of the term infant during the first 7-10 days of life, by definition, the relative content of CD16+CD56-lymphocytes in the peripheral venous blood of pregnant women with threatened miscarriage in the first trimester of pregnancy.

It is known that circulating in the peripheral blood natural killer cells (NK-cells) with the phenotype CD16+in large part do not bear on their surface CD56 molecule and are CD16+D56-cells [13]. Due to the expression on their surface Fcγ receptor type III (CD16) to the Fc-fragment of immunoglobu the ina G NK cells recognize infected with the virus cells on the surface of which sat type G antibodies against viral antigens, and develop in relation to these target cells antibody-dependent cellular cytotoxicity. Earlier studies CD16+CD56-subpopulations of NK in pregnant women in first trimester of pregnancy was not conducted.

The method is performed by a standard method as follows (1):

1) Isolation of lymphocytes from peripheral venous blood;

2) 100 μl of lymphocytes in a concentration of 1×106cells/ml are incubated with 20 μl of monoclonal anti-CD16, FITC labeled with 20 μl of monoclonal anti-D56, labeled D, for 30 minutes at room temperature in the dark, after which the cells washed 1 time with 1 ml of saline by centrifugation at 1500 rpm for 2 minutes. Cells resuspended in 500 μl of saline. The reaction accounting is performed on a flow cytometer, determining the content of CD16+CD56-cells in the lymphocyte gate. The result is read in percent (%).

Significant differences of the claimed method are:

- proposed a new prognostic parameter in the relative content of CD16+CD56-lymphocytes in the peripheral venous blood in women with threatened miscarriage in the first trimester of pregnancy is equal to or less than 11%, to predict the development of local forms of infection-nosplit the selected disease in full-term newborns in the first 7-10 days of life.

The essence of the proposed method is illustrated by the following examples.

Example 1. Pregnant L., 25 years. This second pregnancy. The first pregnancy ended in miscarriage in the period of 8 weeks. In the period of 6-7 weeks was admitted to the hospital complaining of nagging pain in the lower abdomen, spotting from the genital tract. According to ultrasound - pregnancy 7 weeks, hypertonicity of the uterus, echoprint detachment of the ovum.

Diagnosis: Pregnancy 7 weeks. Burdened obstetric history. Threatening miscarriage.

During the examination of the inventive method: the relative content of CD16+CD56-lymphocyte - 5%, below the forecast level for the development of local forms of infectious-inflammatory diseases of the term infant during the first 7-10 days of life.

Conclusion the present method: projected development of local forms of infectious-inflammatory diseases of the term infant during the first 7-10 days of life.

Upon further examination of urogenital infection is detected antigens of chlamydia in the cervical canal and antibody class Ig M for chlamydia in the peripheral blood. After saving therapy she was discharged from the hospital with progressive pregnancy in the period of 10 weeks. The pregnancy ended in timely delivery and ro is based full-term newborn weight 3300 g height of 54 cm, with rating on a scale of Apgar 8/9 points. During examination of the child revealed rhinitis chlamydial etiology. The child has received antibiotic therapy and was discharged on day 7.

Forecast of development of infectious diseases in the newborn by the present method were confirmed.

Example 2. Pregnant With., 26 years. This second pregnancy. The first pregnancy ended in timely delivery and birth of full-term newborn weighing 3000 g, the height of 51 cm, with rating on a scale of Apgar 8/9 points. In the period of 12 weeks was admitted to the hospital with complaints dragging pain in the abdomen, according to ultrasound - pregnancy 12 weeks, hypertonicity of the uterus.

Diagnosis: Pregnancy 12 weeks. Threatening miscarriage.

During the examination of the inventive method: the relative content of CD16+CD56-lymphocyte - 14%, higher than forecast levels on the development of local forms of infectious-inflammatory diseases of the term infant during the first 7-10 days of life.

Conclusion the present method: the development of local forms of infectious-inflammatory diseases of the term infant during the first 7-10 days of life is not expected.

After saving therapy she was discharged from the hospital with progressive pregnancy in the period 14-15 weeks. The pregnancy ended in timely delivery and ro is based full-term newborn weight 3400 g, the height of 51 cm, with rating on a scale of Apgar 8/9 points. The child was discharged on the 5th day with the diagnosis: healthy.

The forecast for the claimed method was confirmed.

Example 3. Pregnant Meters, 23 years. This first pregnancy. A history of infertility for 3 years. Admitted to the hospital with complaints dragging pain in the abdomen, according to ultrasound - pregnancy 10 weeks, the increase in uterine tone. Urine 17-KS and 16.2 mg/day. Examined by an endocrinologist.

Conclusion: hyperandrogenism. Hirsute syndrome. The results of the survey on urogenital infection - negative. Diagnosis: Pregnancy 10 weeks. Threatening miscarriage. Burdened gynecological anamnesis (infertility for 3 years). Hyperandrogenism. Hirsute syndrome.

During the examination of the inventive method: the relative content of CD16+CD56-lymphocyte - 11%, which is predictive in the development of local forms of infectious-inflammatory diseases of the term infant during the first 7-10 days of life.

Conclusion the present method: projected development of local forms of infectious-inflammatory diseases of the term infant during the first 7-10 days of life.

After saving and hormonal therapy the woman was discharged from the hospital with progressive pregnancy in the period of 13 weeks. The pregnancy ended in timely delivery and R is the establishment of a full-term newborn weighing 3000 g, growth of 50 cm, with rating on a scale of Apgar 8/9 points. Upon examination, the child has an infection of the urinary tract. The child has received antibiotic therapy. Discharged home in good condition on day 7.

The forecast for the claimed method was confirmed.

In this way were examined 31 woman 6-13 weeks of gestation. The research results are summarized in table 1

Table
IndexThe number of the examined
Total female31
true-positive result6
false positive result7
a true-negative result18
false-negative result0
Total:
the accuracy of the proposed method is 77,42%
the sensitivity of the proposed method - 100%
the specificity of the proposed method - 72,00%

The advantages of the proposed method:

1. The study of peripheral venous blood of the woman is in early pregnancy (6-13 weeks), what is allows even during pregnancy to predict the development of local forms of infectious-inflammatory diseases of the term infant during the first 7-10 days of life and timely measures, starting in the antenatal period.

2. It is possible to predict the local neonatal infectious and inflammatory pathology before the onset of clinical signs of disease.

3. The method can be used as screening for the development of local forms of infectious-inflammatory diseases of the term infant during the first 7-10 days of life.

4. The inventive method is simple to implement, does not require time-consuming and is carried out within 1 hour and 40 minutes.

5. High precision 77,42%, sensitivity 100% and specificity 72,00% of the way.

Thus, the claimed method is simple to perform and allows high accuracy to predict the development of local forms of infectious-inflammatory diseases of the term infant during the first 7-10 days of life in women with threatened miscarriage in the examination in the first trimester of pregnancy that will allow you to choose the right tactics for the management of women with risk of development of local forms of infectious-inflammatory diseases of the term infant during the first 7-10 days of life, in a timely manner to carry out preventive measures and will contribute to the reduction in the incidence of this pathology of the fetus and newborn, and reduce economic costs for treatment.

References:

1. Boyum A. Isolation of mononuclear cell and granulocytes from uman blood and bone marrow // ScandJ.Clin.Lab.Invest. - 1968. - v.21. No. 97. - R.

2. Cetlinski S.A., Kalinin NM Immunology for clinicians. - Saint-Petersburg., 1998. - 110 S.

3. Clinical immunology: a Textbook for medical students / edited Averella. - M: Medical information Agency, 1999. - 604 S.

4. The Yarylo A.A. fundamentals of immunology: a Textbook. - M.: Medicine., -1999, - 608 S.

5. Shabalov, NP Neonatology. T.1. - SPb.: Special literature, 1995. - 494 S.

6. Yatsyk GV Manual of neonatology. - M., 1998. - 400 C.

7. Sidorov, I.S., Chernienko I.N. Intrauterine infections: chlamydia, mycoplasmosis, herpes, cytomegalovirus // ROS. Journal of Perinatology and Pediatrics. - 1998. - C, No. 3. - P.7-13.

8. Simakova MG, Smirnov, V.S., A. Durov Clinic, diagnostics and treatment of intrauterine infection // Obstetrics and gynecology. - 1995. No. 4. - S. 7-9.

9. ECCO L.A. Modern medical technologies for the early diagnosis and treatment of intrauterine infection and placental insufficiency // health Protection of mother and child: a book of abstracts. The role of infection in the pathology of the reproductive system in women, the fetus and newborn. - Moscow: Morag EXPO, 2000. - P.119-121.

10. Patent No. 2102753, Russia. A method for predicting bacterial complications neonates / Overwiev, Tin, Yea, Entamoeba (Russia) // Bulletin of inventions. - 1998. No. 2. - part 2. - s.

11. A.S. No. 1778706, Russia. A method for predicting infecti the NGO-inflammatory pathology in preterm neonates / Amitrole, Haemelinen, Nagornoe (Russia) // O. "Inventions". - 1992. No. 44. - C.148.

12. Torubarov N.A., Koshel IV, Yatsyk GV Blood of the fetus and newborn - M.: Medicine, 1993. - P.95-117.

13. Khaitov R.M R.M., Ignatieva GA, Sidorovich I.G. Immunology: a Textbook. - M.: Medicine, 2000. - 432 S.

A method for predicting infectious disease in full-term newborns by examining peripheral blood, characterized in that in the first trimester of pregnancy (6-13 weeks) in peripheral venous blood of women with threatened miscarriage determine the relative content of CD16+CD56-lymphocytes and its value is equal to or less than 11%, predict the development of infectious disease in full-term newborns in the first 7-10 days of life.



 

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