The impact of therapeutic hypothermia on peripheral blood cell in newborns with hypoxic ischemic encephalopathy

Abstract

The effect of hypothermia treatment on white blood cell (WBC), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) values as an indicator of inflammation was evaluated in newborns with hypoxic ischemic encephalopathy (HIE). The study was performed that the before-therapeutic hypothermia (TH) and after-TH WBC, lymphocytes, neutrophils, monocytes and NLR, LMR and PLR values of the complete blood cell count were retrospectively evaluated. The results of the patient group were compared with the results of healthy newborns. A total of 78 patients who underwent TH were evaluated in our study. Mean values before and after TH were NLR3.8/2.7, LMR 5.6/8.6, and PLR 60.3/67.1 respectively. A statistical significance was present for NLR values before and after TH in those with seizure in our study (4.15±2.95/3.01±2.54) but no statistical significance was found for LMR or PLR. In neonates with HIE, effect of TH on complete blood cell count and inflammatory mechanisms (mediated neutrophil and lymphocyte) may be minimal.

Neutrophil Extracellular Traps Release following Hypoxic-Ischemic Brain Injury in Newborn Rats Treated with Therapeutic Hypothermia

“…Studies in human patients with stroke have shown a high number of peripheral neutrophils being associated with the severity of injury [ 71 ], as well as in neonatal HI associated with poorer neurological outcomes [ 26 ]. It has been shown that TH has a minimal effect on peripheral immune cell counts in neonatal HI cases [ 72 ]; however, HI neonates undergoing TH have altered inflammatory responses compared to healthy infants [ 73 ]. It is commonly believed that an increase in neutrophil count after HIE is possibly associated with an infection and adverse outcome; however, evidence has shown no significant changes in the neutrophil count in asphyxiated newborns [ 27 ], even less during TH [ 72 ].…”

“…It has been shown that TH has a minimal effect on peripheral immune cell counts in neonatal HI cases [ 72 ]; however, HI neonates undergoing TH have altered inflammatory responses compared to healthy infants [ 73 ]. It is commonly believed that an increase in neutrophil count after HIE is possibly associated with an infection and adverse outcome; however, evidence has shown no significant changes in the neutrophil count in asphyxiated newborns [ 27 ], even less during TH [ 72 ]. Recently, studies in adult animal models of stroke have demonstrated the critical role of neutrophils in the development of inflammation [ 17 , 18 , 19 , 20 , 57 , 65 ]; however, few studies using neonatal HI models have supported this, and the exact role of neutrophils is poorly understood [ 23 , 65 ].…”