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ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 1  |  Page : 187-191

Mean platelet volume as a prognostic factor in neonatal respiratory distress


1 Pediatrics Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
2 Pediatrics Department, Shebin El-Kom Fever Hospital, Shebin El-Kom, Egypt

Date of Submission23-Mar-2019
Date of Decision04-Apr-2019
Date of Acceptance14-Apr-2019
Date of Web Publication27-Mar-2021

Correspondence Address:
Ahmed G.S. Ali
Pediatrics Department, Shebin El-Kom Fever Hospital, Shebin El-Kom, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_111_19

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  Abstract 


Objective
To evaluate mean platelet volume (MPV) as a prognostic factor in neonatal respiratory distress.
Background
Respiratory distress syndrome (RDS) is a major cause of morbidity and mortality in preterm infants. MPV is an indicator of platelet function. It may be considered a risk factor for the development of RDS.
Patients and methods
This was a case–control study conducted on 50 (21 males and 29 females) Egyptian preterm neonates. Of them, 25 were previously diagnosed as having RDS, as a patient group, and 25 were apparently healthy age-matched and sex-matched neonates as a control group. All of them were subjected to full history and physical examination. Blood samples were taken on first and third day. Blood for complete blood count was obtained by either venipuncture, arterial puncture, or through a central catheter. complete blood count included MPV, platelet count, and white blood cell count.
Results
MPV on the first day (fl) in the study group [10.8 (9.1, 11.2)] was significantly higher than controls [7.9 (7.6, 8.2)], with P value less than 0.001. MPV on third day (fl) in study group [11.5 (10.4, 12.2)] was significantly higher than controls [8.3 (8.1, 8.5)], with P value less than 0.001. However, platelet count on third day (×109/μl) in the study group [146 (103, 170)] was significantly lower than in controls [176 (150, 202)], with P = 0.032.
Conclusion
MPV is a simple and readily available biomarker, and it is indicated that platelet may have been involved in the physiopathologic process of RDS.

Keywords: mean platelet volume, neonates, precautions, preterm, respiratory distress syndrome


How to cite this article:
El Mashad GM, El Saied HM, Ali AG. Mean platelet volume as a prognostic factor in neonatal respiratory distress. Menoufia Med J 2021;34:187-91

How to cite this URL:
El Mashad GM, El Saied HM, Ali AG. Mean platelet volume as a prognostic factor in neonatal respiratory distress. Menoufia Med J [serial online] 2021 [cited 2021 May 8];34:187-91. Available from: http://www.mmj.eg.net/text.asp?2021/34/1/187/311986




  Introduction Top


Respiratory distress syndrome (RDS) is one of the major important diseases in neonatal ICU and a major cause of morbidity and mortality in preterm infants. RDS is an acute disease usually of preterm infants. It presents within 4–6 h of life and is characterized by tachypnea, respiratory distress with retraction, grunting, and cyanosis [1]. On chest radiograph, there is typical presence of reticulogranular mottling with air bronchograms, and also in severe cases, the lung fields may be entirely opaque owing to fluid retention in the air spaces and alveolar atelectasis. Approximately 2–3% of infants present with respiratory distress shortly after birth, 50% of the neonates born between 26 and 28 weeks of gestation present with RDS, whereas less than 20–30% of preterm infants at 30–31 weeks have the disease [2]. The main etiology of RDS is surfactant deficiency; however, there are several other physiopathologic and histopathologic findings regarding the lungs of these infants [3]. In microcirculation and alveolar spaces of preterm neonates with severe RDS, fibrin deposits were found [4]. It can be explained by the stimulation of the coagulation system or inadequate fibrinolysis [5]. Platelets play a role in fibrin formation and deposition. It is also known that platelet counts (PCs) of newborns with RDS are less than in those without RDS [6]. However, there is no sufficient evidence on the role of mean platelet volume (MPV) in preterm neonates with RDS. Association between maternal and adverse neonatal outcome has been reported [7].

The aim of this study was to assess the role of MPV as a prognostic factor for RDS in preterm neonates. Owing to a lack of similar study in Egypt, we conduct this study in NICU of Menoufia University.


  Patients and methods Top


After approval of the Local Institutional Ethical Committee of Menoufia University Hospital and after taking a written consent from parents of the studied neonates to be included in the study, our case–control study was conducted on 50 preterm neonates with the diagnosis of RDS. The patients were randomly selected from those attending the NICU of Menoufia University Hospital in the period from May 2018 to February 2019. Neonates included were preterm infants with a gestational age of less than 34 weeks. RDS was confirmed on the presence of typical clinical and radiological signs of the disease. The study included both males and females. Full-term infants as well as preterm infant with significant perinatal hypoxia, necrotizing enterocolitis, sepsis, cardiac and other congenital anomalies, and also preterm infant delivered to mothers with history of severe pre-eclampsia, use of antiepileptic, and other drugs with negative effects on platelet production, or diabetes mellitus, and infections including chorioamnionitis were excluded from the study. The neonates included in the study were divided into two groups: group I had preterm neonates with signs and symptoms suggestive of RDS, and group II consisted of 25 healthy preterm neonates.

All patients and controls were subjected to complete detailed history in the form of name, age, sex, residence, maternal history, history of the present illness, and family history; full clinical examination, including gestational age (weeks) by new Ballard score, mode of delivery, and birth weight (kg); and laboratory investigations, including chest radiograph and complete blood count (CBC) with the values of hemoglobin level (g/dl), hematocrit (%), mean corpuscular volume (fl/red cell), white blood cell count (WBC) (×109/l), MPV and PC (×109/μl). Investigations were done by taking blood from the patient and healthy groups. Blood samples were drawn from umbilical cord in the first 2 h of life before any feeding, medication, and intravenous fluid infusion. On postnatal day 3 (48–72 h), CBC was repeated. Blood for CBC was obtained either by venipuncture (The skin over the vein was sterilized by 70% alcohol) or through a central catheter. The samples were used for CBC (including PC and MPV). Automated analyzer (PHONIX – NCC 3300- Bulevar sv.; Cara Konstantina, Serbia, Europe) was used. Whole blood sample was used for the blood counts. The reference range for MPV was between 7.0 and 11 fl.

Statistical analysis

Data were collected and entered to the computer using statistical package for the social sciences 18 (SPSS Inc., Chicago, Illinois, USA) program for statistical analysis. Data were entered as numerical or categorical, as appropriate. Two types of statistics were done: (a) descriptive statistics, in which quantitative data were expressed in mean ± SD for normally distributed variables, and median with interquartile range for nonnormally distributed variables [50th (25th, 75th)], and (b) qualitative data, which were expressed in number (frequency), and percent. Analytical statistics were done by using χ2-test and Fisher exact test to measure the association between qualitative variables as appropriate. Moreover, Student t-test is a test of significance used for comparison between two groups having quantitative variables. Mann–Whitney test (nonparametric test) is a test of significance used for comparison between two groups not normally distributed having quantitative variables. The level of significance used was 95%, and the margin of error accepted was set to 5%, so P value of less than 0.05 was considered statistically significant. To define the optimal cutoff level of MPV measured for predicting RDS, receiver operating characteristic curve analysis was used. The results of comparing the correlation between two continuous variables were indicated by the correlation coefficient (r) using correlation analysis.


  Results Top


A total of 50 Egyptian preterm neonates were classified into two groups: the patient group included 25 preterm neonates diagnosed as having RDS (group A) and a control group (group B) included 25 apparently healthy age-matched and sex-matched neonates. Sex distribution in group A included 10 (40%) males and 15 (60%) females, and group B had 10 (40%) males and 15 (60%) females [Table 1]. Mode of delivery in group A was seven (28%) cesarean section (CS) and 18 (72%) normal vaginal delivery and group B was seven (28%) CS and 18 (72%) normal vaginal delivery, with no statistically significant difference (P > 0.05). Moreover, gestational age (weeks) in group A was 32 (31, 33) and in group B was 33 (33, 34), with no statistically significant difference (P > 0.05). Birth weight (kg) in group A was 1.54 (1.49, 1.8) and in group B was 2.0 (1.8, 2.28), with statistically significant difference (P < 0.001; [Table 1]). The hemoglobin level (g/dl) in group A was 15.86 ± 1.74 and in group B was 16.1 ± 1.28. Mean corpuscular volume (fl/red cell) in group A was 98.74 ± 8.25 and in group B was 97.13 ± 7.09. WBC count (×109/l) in group A was 11.1 (10, 12.2) and in group B was 9.2 (8.1, 10.3), and PC on first day (×109/μl) in group A was 180 (115, 205) and in group B was 203 (156, 254), with no statistically significant difference (P > 0.05). MPV on first day (fl) in group A was 10.8 (9.1, 11.2) and in group B was 7.9 (7.6, 8.2), with statistically significant difference (P < 0.001). MPV on third day (fl) in group A was 11.5 (10.4, 12.2) and in group B was 8.3 (8.1, 8.5), with statistically significant difference (P < 0.001). PC on third day (×109/μl) in group A was 146 (103, 170) and in group B was 176 (150, 202) with statistically significant difference (P = 0.032). Mortality outcome in group A was eight (32%) died and 17 (68%) survived and in group B was two (8%) died and 23 (92%) survived, with statistically significant difference (P = 0.034; [Table 2]). On correlation analysis, gestational age (weeks) in group was A -0.397 and in group B was − 0.483. Birth weight (kg) in group A was −0.463 and in group B was −0.560. Hemoglobin level (g/dl) in group A was −0.093 and in group B was −0.078. Mean corpuscular volume (fl/red cell) in group A was 0.113 and in group B was 0.189. WBC count (×109/l) in group A was 0.199 and in group B was 0.214. MPV on first day (fl) in group B was 0.902. MPV on third day (fl) in group A was 0.902. PC first day (×109/μl) in group A was −0.111 and in group B was −0.204 and PC third day (×109/μl) in group A was −0.031 and in group B was 0.157 [Table 3]. In receiver operating characteristic curve analysis, we explored the relation between MPV and development of RDS. MPV value of '8.5' on first day of life and '8.6' on third day of life were identified as an effective cutoff point, with an area under the curve of 0.863 and 0.935, respectively, making them to be considered as an effective prognostic marker, and a P value less than 0.001. They yielded a sensitivity of 78.57 and 82.14%, respectively, a specificity of 86.36 and 90.91%, respectively, a positive predictive value of 88 and 92%, respectively, negative predictive value of 76 and 80%, respectively, and a diagnostic accuracy of 82 and 86%, respectively [Figure 1] and [Figure 2].
Table 1: Demographic data of the studied groups

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Table 2: Laboratory data of studied groups

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Table 3: Correlation between mean platelet volume (on first day and on third day) and other quantitative study parameter

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Figure 1: Receiver operating characteristic (ROC) curve analysis of mean platelet volume (MPV) (on first day) for predicating respiratory distress syndrome (RDS).

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Figure 2: Receiver operating characteristic (ROC) curve analysis of mean platelet volume (MPV) (on third day) for predicating respiratory distress syndrome (RDS).

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  Discussion Top


MPV is an important cardiovascular risk-predicting factor in children and adults, which has a predictive value for the appearance of stroke and acute myocardial infarction [8]. MPV is an indicator of platelet activation, which is a central process in the pathogenesis of coronary heart disease. MPV is increased in diabetes, obesity, and rheumatologic and systemic diseases such as psoriasis and familial Mediterranean fever [9]. Prematurity is one of the most important factors determining neonatal morbidity and mortality [10]. In Egypt, prematurity was the main cause of neonatal mortality (39%), followed by asphyxia (18%), infections (7%), congenital malformations (6%), and unclassified (29%). Fahmy et al. [11] reported that preterm represented 39% of the NICU admissions through one year in Egypt. RDS is one of the most commonly encountered diseases in NICU and one of the major causes of mortality and morbidity in preterm infants. According to Pike and Lucas [12], respiratory problems associated with preterm birth include RDS, and this was confirmed by Vrijlandt et al. [13], who stated that preterm neonates are at a high risk for respiratory problems during their first 5 years of life. In this study among 50 preterm infants, there was no significant difference in sex, as 23 (46%) neonates were males and 27 (54%) were females. This is in accordance with Challis et al. [14], who reported that there was no significant difference in sex and age. Results of this study showed non-statistically significant difference between preterm with and without RDS regarding sex. This in accordance with Canpolat et al. [15], who reported that there was statistically insignificant difference between infants with and without RDS regarding sex. Results of this study show insignificantly difference between preterm with and without RDS regarding mode of delivery results. This is in accordance with Liu et al. [16], who reported that there was no significant difference between preterm with and without RDS regarding mode of delivery. Our study findings showed the majority of preterm neonates were delivered by CS (58%), and this in accordance with Holzer [17], who conducted a study on 1320 singleton preterm infants born at 23 ± 0 and 27 ± 6 weeks and found the overall rate of CS to be 73.5%. In this study, hemoglobin level was not significantly different in group A compared with group B, whereas MPV on first day was significantly higher in RDS preterm. Analysis of data obtained on day 3 shows that MPV was still significantly higher in the RDS group of preterm. WBC count was insignificantly higher as well as platelets were lower in both first day (but not to a significant degree) and third day (to a significant degree). MPV was significantly higher on day 1 and 3. This is in accordance with Sweet et al. [18], who reported that there was a nonsignificant difference regarding hemoglobin level, WBC, platelet co and MPV and that MPV was significantly higher on day 1 and day 3. In this study, a negative correlation between platelet co and MPV is observed consistently in both groups of infants. This finding is concordant with Aliberti et al. [19] who reported that there was a negative correlation between platelet co and MPV. According to the findings of previously mentioned studies, MPV appears to be a marker of platelet production and consumption and may also be related to the severity of some diseases associated with bone marrow, thrombosis, and infections. Lastly, Wang et al. [20] conducted a retrospective study on 232 neonates admitted to the neonatal intensive care unit and diagnosed with neonatal RDS to find more effective diagnosis and treatment of neonatal RDS through comparatively analyzing the different gestational neonates with RDS ,risk factors, clinical characteristics, treatment, and prognosis, and found that the mortality rate was 9%. In this study, mortality rate among healthy preterm neonates was 8%, whereas it was 32% in preterms with RDS. Such difference can be attributed to the small sample size of our study.


  Conclusion Top


Based on the results of this study, it can be concluded that MPV, a simple and readily available biomarker, is significantly higher in preterm neonates with RDS than preterm neonates without RDS.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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