Does red cell distribution width predict mortality in newborns with early sepsis?

Abstract

We readwith great interest the recent original article by Jo et al [1] published recently in this journal, which demonstrated that red cell distribution width (RDW) was associated with 28-day mortality in patients with severe sepsis and septic shock. The authors stated that RDW of nonsurvivors was higher than that of survivors in severe sepsis and septic shock, and there was a graded association between RDW and 28-day mortality. In addition, RDW had a relationship with the severity of the patients and was an independent prognostic factor of 28-day mortality in patients with severe sepsis and septic shock. Although experience about RDW as a prognostic factor is increasing, there is still a debate about it and no experience in pediatric population especially in newborn. We would like to present our experience related to RDW in neonatal sepsis. We evaluated the RDW values of 46 extremely low birth weight infants (birth weight b1000 g) with early sepsis. Sixteen (35%) of the infants were dead during this period. There was no statistically difference in both survivor and nonsurvivor groups with respect to sex, gestational age, birth weight, vaginal delivery rates, and Apgar 1’ andApgar5’ scores.Whenpatientsweredivided into 3groups according to RDW, the mortality rate did not change with increasing tertiles of RDW. The clinical risk index for babies (CRIB) scores did not change according to RDW tertiles. The authors stated that elevation of RDW in sepsis might be associated with inflammation. Proinflammatory cytokines such as tumor necrosis factor α, interleukin-6 (IL-6), and interleukin-1β could suppress red blood cell maturation and decrease the half-life of red blood cells. In our patients, IL-6 levels and also C-reactive protein levels were analyzed, and there was no correlation between IL-6 and C-reactive protein levels and RDW. Red cell distribution width could be elevated in any conditions in which red blood cell is produced ineffectively or increasingly destructed, which result in release of reticulocytes, and several possiblemechanisms have been suggested. Red cell distributionwidth does not predict the mortality in extremely low birth weight infants with early sepsis.