Combined detection in type identification and curative effect evaluation of neonatal infectious pneumonia

Combined detection in type identification and curative effect evaluation of neonatal infectious pneumonia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Combined detection in type identification and curative effect evaluation of neonatal infectious pneumonia Xin Zhao, Pinglin Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7353556/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective : To explore the significance of combined detection of serum hemoglobin (Hb), lactic acid (LAC) and immunoglobulin in the differential diagnosis and curative evaluation of neonatal infectious pneumonia (NIP). Methods : From January 2022 to December 2022, 80 hospitalized children with neonatal infectious pneumonia were selected as the experimental group, which were divided into bacterial pneumonia and non-bacterial pneumonia groups according to the results of the etiological analysis. Meanwhile, 40 healthy children from child health clinics were selected as the control group according at a ratio of 2:1 based on age and sex. The children in the experimental group received appropriate antibiotic treatment, fasting venous blood was collected before and after treatment, and serum Hb, LAC and immunoglobulin (IgG, IgA, IgM) levels were measured. The serum Hb, LAC and immunoglobulin levels were compared between the experimental and control groups. To compare serum Hb, LAC and immunoglobulin levels between the experimental and non-bacterial pneumonia groups. To compare serum Hb, Lactoferrin and Immunoglobulin levels before and after treatment in the experimental group. To plot the receiver operating characteristic curve (ROC) and analyze the diagnostic efficacy of the serum Hb, lactoferrin and immunoglobulin in differentiating the type of neonatal infectious pneumonia and evaluating the efficacy of treatment. Results : Compared to the control group, newborns in the experimental group had lower levels of serum Hb and higher levels of immunoglobulin G (IgG), IgA and IgM (P<0.05). Compared to the non-bacterial pneumonia group, the bacterial pneumonia group had lower levels of serum Hb, LAC and higher levels of IgM (P0.05). Serum Hb levels were higher and LAC, IgG, IgA and IgM levels were lower (P<0.05) in the NIP effective group than in the NIP ineffective group. The AUCs of serum Hb, LAC and IgM for the differential diagnosis of NIP infection types were 0.647, 0.732 and 0.698 respectively, and the AUC for the combined diagnosis of the three was 0.818, which was higher than that of a single factor (P<0.05). The AUCs of serum Hb, LAC, IgG, IgA and IgM for single diagnosis of NIP were 0.696, 0.676, 0.751, 0.603, 0.825, and the AUC of the combined diagnosis was 0.912, which was higher than that of a single diagnosis (P<0.05). Conclusion : Serum Hb, LAC and immunoglobulin levels of IgG, IgA and IgM can be used to assess the efficacy of NIP, Hb, LAC and IgM can also be used to identify the type of NIP infection, and the combined diagnosis has the highest clinical value. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Biological sciences/Microbiology Hemoglobin Lactic acid Immunoglobulin Neonate Infectious pneumonia Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Neonatal Infectious pneumonia (NIP) is the most common infectious disease in the neonatal period. Neonates with weak immune system are susceptible to bacterial, viral and other pathogenic microorganisms, and the onset of NIP can lead to respiratory distress, fever, coughing and wheezing, and in severe cases, shock or even death, which is the main cause of neonatal mortality. Therefore, rapid identification of the type of NIP infection and effective treatment is the key to improving neonatal survival and treatment outcome [1] . However, the lack of specific signs and clinical symptoms in the early stage of NIP, culture, isolation and identification of pathogenic microorganisms are the gold standard for determining the type of NIP in neonates, but the test results are often lagging behind the clinical use of medication, resulting in the emergence of drug-resistant strains and poor therapeutic effects. Therefore, exploring new and reliable methods for identifying NIP types is a prerequisite for targeted antibiotic application and improvement of therapeutic efficacy. Domestic studies have shown that infection alters the human hematopoietic microenvironment, which is associated with iron deficiency anemia [2] . Overseas studies have found that a decrease in hemoglobin (Hb) levels in a short period of time after pneumonia diagnosis may be a predictive indicator of the deterioration of pneumonia in patients with COVID-19, and it has been postulated that hemoglobin Hb may be involved in the occurrence and development of NIP [3] . Lactic acid (LAC) is widely found in human and animal metabolic processes, and is an important indicator of blood perfusion and cellular hypoxia. It showed that its expression level in serum is closely related to the disease status of pneumonia patients [4] . Immunoglobulin, as a major component of the body's humoral immune response, is a common indicator for assessing individual immune status [5, 6] . Studies have reported increasing inflammation and altered immune status in children with NIP, and modulation of immune function may improve the condition, especially immunoglobulin M (IgM), which is significantly altered in pediatric pneumonia. Therefore, the present study attempted to analyze the changes and clinical significance of serum Hb, LAC and IgM levels in children with NIP to provide new diagnostic factors for early targeted antimicrobial therapy in newborns with NIP. Information and methodology All methods were carried out in accordance with relevant guidelines and regulations; all experimental protocols were approved by the Ethics Committee of Zunyi First People's Hospital and the relevant licensing committees; informed consent was also obtained from all legal guardians of the participants. 1.1 General information From January 2022 to December 2022, 80 hospitalized children diagnosed with NIP were included in the experimental group. Inclusion criteria: (1) full-term delivery of newborns (age 0-28 days); (2) a history of exposure to respiratory infections, respiratory tract infection symptoms, lung signs, chest X-rays showed pneumonia features, in line with the diagnostic criteria of NIP [7] ; (3) the clinical data is complete, and the supervisor signed the informed consent form. Exclusion criteria: (1) concurrent with other infectious diseases; (2) received relevant treatment before enrollment; (3) concurrent with other lung diseases, congenital anomalies, genetic and metabolic diseases, etc.; (4) history of immunoglobulin, hormone and immunosuppressant application. In the same period, 40 healthy children were selected from the child health care clinic for health examination in the ratio of 2:1 by age and gender, and their general information such as age and gender were complete in the control group. There was no statistically significant difference between the general information of the two groups (P>0.05), see Table 1. Table 1. Comparison of general information of newborns in experimental and control groups groups Sex (male) Gestational age (weeks) Age (days) Birth weight (kg) Experimental group 80 42 37.96±1.47 18.45±3.39 3.64±0.43 Control group 40 20 38.05±1.78 18.98±3.27 3.61±0.45 T/χ² 0.067 0.124 0.616 0.264 P 0.796 0.832 0.540 0.793 1.2 Methodology Detection method：A 5mL venous blood sample was collected from both groups of newborns on the morning of the next day after hospitalization on an empty stomach, and the serum was immediately separated within 0.5 min and stored in a refrigerator at -20℃ for 15 min. Hb and LAC were measured by Gem Premier 3000 blood gas analyzer, and serum IgG, IgA and IgM levels were measured by automatic biochemical analyzer. The normal values of the above indexes for newborns ranged from 110 to 160 g/L for Hb, 0.5 to 1.6 mmol/L for LAC, 7 to 16 g/L for serum IgG, 0.7 to 4 g/L for IgA and 0.7 to 2.3 g/L for IgM. Treatment and efficacy evaluation：Newborns in the experimental group were treated routinely, including antibiotic treatment according to the drug sensitivity test, maintaining sufficient temperature and humidity, rehydration, correcting electrolyte disorders and acid-base balance, supplying oxygen to those with respiratory distress, keeping the airway open, and injecting human immunoglobulin intravenously if necessary. The efficacy of the treatment was observed in 5 days, and the newborns were regarded as effective if the symptoms of respiratory distress and cyanosis disappeared, the symptoms of coughing, wheezing, and wet rhonchi of the lungs were significantly improved, and the newborns did not have any choking, spitting up, fever, or weakness of heart, and their urine and feces were normal and their blood gas indexes were normal or basically normal; and the newborns who failed to meet the above criteria were considered to be ineffective. Grouping：The experimental group was divided into 49 cases in the bacterial pneumonia group and 31 cases in the non-bacterial pneumonia group according to the results of pathogenetic analysis. The experimental group was divided into 58 cases in the NIP effective group and 22 cases in the NIP ineffective group according to the effect of NIP treatment. 1.3 Statistical methods The data of this experiment were analyzed using SPSS24.0 statistical software, and the measurement data were expressed as mean ± standard deviation (x±s), and the t-test of independent samples was conducted to compare the two groups. Count data were expressed as the number of cases n, and x² test was adopted. The diagnostic value was obtained by plotting the Receiver operating characteristic curve (ROC) curve to obtain the AUC, 95% confidence interval, sensitivity, specificity and cut-off value. p<0.05 means that the difference is statistically significant. Results Comparison of serum Hb, LAC and immunoglobulin levels between the experimental group and the control group Compared with the control group, the experimental group had lower serum Hb levels and higher LAC and immunoglobulin levels of IgG, IgA, and IgM, and the differences were statistically significant (P<0.05), as shown in Table 2. Table 2 Neonatal testing indicators in experimental and control groups (x±s) groups Hb(g/L) LAC (mmol/L) IgG (g/L) IgA(g/L) IgM(g/L) Experimental group 80 152.69±16.42 1.87±0.59 16.39±3.54 4.41±1.33 2.72±0.73 Control group 40 167.75±17.55 1.41±0.35 12.46±3.43 2.69±0.75 1.79±0.34 t 4.629 4.542 5.792 7.588 7.642 P <0.001 <0.001 <0.001 <0.001 <0.001 Comparison of serum Hb, LAC and immunoglobulin levels in children with different types of NIP infection revealed that serum Hb levels were lower in the bacterial pneumonia group, while LAC and IgM levels were higher (P0.05), as shown in Table 3. Table 3 Serum Hb, LAC and immunoglobulin levels (x±s) in children with different types of infection in NIP. groups Hb(g/L) LAC (mmol/L) IgG(g/L) IgA(g/L) IgM(g/L) Bacterial pneumonia group 18 149.53±16.37 1.69±0.48 16.32±3.67 4.39±1.33 2.91±0.75 Non-bacterial pneumonia group 62 157.68±15.44 2.17±0.64 16.51±3.38 4.45±1.37 2.44±0.61 t 2.217 3.823 0.232 0.194 2.928 P 0.030 0.001 0.817 0.843 0.004 Comparison of serum Hb, LAC and immunoglobulin levels between the NIP effective group and the NIP ineffective group Compared, the NIP effective group had a higher level of serum Hb, and a lower level of LAC, IgG, IgA, and IgM, and the differences were statistically significant (P<0.05), as shown in Table 4. Table 4 Comparison of serum Hb, LAC and immunoglobulin levels in those with different clinical outcomes of NIP (x±s) groups Hb(g/L) LAC (mmol/L) IgG(g/L) IgA(g/L) IgM(g/L) NIP active Group 23 163.54±18.63 1.59±0.34 13.72±3.81 2.65±0.44 1.65±0.43 NIP Invalid Group 57 151.15±20.32 1.97±0.61 17.04±3.49 3.12±0.91 2.37±0.66 t 2.591 3.532 3.558 3.109 5.724 P 0.011 0.001 0.001 0.003 <0.001 ROC curves were used to analyze the diagnostic efficacy of serum Hb, LAC and immunoglobulin IgM levels in the diagnosis of NIP infection types. The AUCs of serum Hb, LAC and IgM for differential diagnosis of NIP infection types were 0.647, 0.732 and 0.698, respectively, and the AUC for the combined diagnosis of the three was 0.818, which was higher than that of a single factor (P<0.05 for all three factors), as shown in Table 5 and Figure 1. Table 5 Diagnostic efficacy of serum Hb, LAC and immunoglobulin IgM levels on the type of NIP infection serum factor AUC 95% confidence interval Sensitivity (%) Specificity (%) cut-off value Hb 0.647 0.533-0.751 69.39 70.97 ≤153.35 LAC 0.732 0.622-0.825 69.39 74.19 ≤1.9 IgM 0.698 0.585-0.796 40.82 96.77 0.698 unite 0.832 0.732-0.906 83.67 67.74 ROC curves were used to analyze the diagnostic efficacy of serum Hb, LAC and immunoglobulin levels for NIP efficacy. The AUCs of serum Hb, LAC, IgG, IgA and IgM for single and combined diagnosis of NIP efficacy were 0.696, 0.676, 0.751, 0.603, 0.825, and 0.912 in the following order, and the combined diagnosis method was higher than that of single diagnosis (P<0.05), as shown in Table 6 and Figure 2. Table 6 Diagnostic efficacy of serum Hb, LAC and immunoglobulin levels for NIP efficacy serum factor AUC 95% confidence interval Sensitivity (%) Specificity (%) cut-off value Hb 0.696 0.583-0.794 60.34 81.82 >161.59 LAC 0.676 0.562-0.776 98.28 45.45 ≤2.16 IgG 0.751 0.642-0.841 79.31 68.18 ≤16.3 IgA 0.603 0.487-0.711 98.28 40.91 ≤3.32 IgM 0.825 0.724-0.901 75.86 77.27 ≤1.87 unite 0.912 0.828-0.964 93.10 81.82 At the same time, the concentration of Hb, LAC, IgG, IgA and IgM in the blood of NIP patients was detected by ELISA. The results showed that the concentration of Hb, LAC, IgG, IgA and IgM in NIP patients much higher than that in normal newborns (P<0.05), as shown in Figure 3. It was collected the serum of the patients and detected the serum protein expression of IGA by western blot assay. And we found that the trend was consistent with the ELISA results, the expression of IgA, IgM and IgG levels of Hb in NIP patients much higher than that in normal newborns, as shown in Figure 4. Discussion The pathogen of NIP mainly originates from vertical transmission from mother to child and respiratory colonisation, and because of the low immunity of newborns, it is easy to develop into a serious infection, which should be diagnosed and treated in a timely manner [1, 8] . Currently, pneumonia is mainly diagnosed by symptoms such as cough, shortness of breath and chest X-ray findings, but the cough reflex of neonates has not been fully formed, the respiratory muscles are weak, coupled with the lung signs are often not obvious in the early stage, it is easy to ignore and delay treatment, increasing the risk of death, and therefore, exploring new diagnostic methods is very necessary. In recent years, serological tests have attracted much attention because of their simplicity, low cost, rapidity, safety and other advantages, and have been used in the etiological diagnosis of NIP with certain results [9] . In this study, serum Hb, LAC and immunoglobulin were selected as the diagnostic factors of NIP. Table 1 shows that the serum Hb level of the experimental group was lower than that of the control group, and the levels of LAC, IgG, IgA and IgM were higher than those of the control group, suggesting that the newborns with NIP may have a reduced serum Hb, an elevated LAC and immunoglobulin level, and that the five serological factors mentioned above may have a role in the diagnosis of NIP. The reason for this analysis is that Hb is one of the indicators for clinically assessing the nutritional status of the organism and determining whether there is anemia or not, and foreign studies have found that there is a certain correlation between anemia and viral infections in children [10-12] . Anemia is easy to occur in severe infections, and after the anemia reaches a certain level, the oxygen transport capacity of blood decreases, and insufficient oxygen supply may damage tissues and organs [13] . However, due to the slow development of anemia and the seriousness of NIP symptoms, anemia is often overlooked, resulting in the complication of NIP, prolonging hospital stay and even affecting the prognosis. Traditionally, elevated LAC is thought to be caused by the accumulation of hypoxia in the body, but in fact, high levels of LAC are also associated with infections in the body: NIP patients have reduced enzyme activity, insufficient perfusion of organs and tissues, hypoxia in lung tissue cells, and reduced mitochondrial oxygen transport, resulting in elevated levels of serum LAC; and when the lungs are damaged in NIP, the rate of fibrin conversion is accelerated, resulting in the body's release of even more LAC [14, 15] . Serum LAC has been recognized as a biomarker for the prognosis of sepsis, and foreign animal experiments have proved that high lactate cycle level is related to the severity of sepsis and mortality [16] . As the theory of the immune function of infection becomes more and more perfect, medical workers realize that the pathological changes that occur after microorganisms such as bacteria, viruses and mycoplasma infect the cells of the organism are a complex process, and that the balance of the acquired immunity of the host determines the occurrence of the infection and the regression of the infection [17, 18] . Immunoglobulins (IgA, IgM, IgG) are indicators of humoral immunity in neonates, which mainly protect the organism through antibodies produced by effector B cells, among which IgA plays the role of an immunity barrier in the mucous membrane of epithelial cells of neonates' respiratory tracts, and its level may be abnormally elevated in the event of respiratory tract infections in neonates; IgM has an anti-infective effect, and it can stimulate complement, whose concentration increases sharply in the peripheral blood after an infection; IgG has an anti-infective effect, and can stimulate complement, whose concentration increases sharply in the peripheral blood after an infection. IgM has an anti-infective effect and can activate complement, and its concentration in peripheral blood increases sharply after infection; IgG is a neutralizing agent that also activates complement, and its level can be increased gradually after infection to clear pathogens [19-21] . In addition, according to Table 4 and Figure 2, the above five serological factors can also be used to assess the efficacy of NIP, and the AUC of the combination of these factors is 0.912, which shows that the combination of these factors is highly effective in diagnosing the efficacy of NIP. In view of the above, serum Hb, LAC, IgA, IgM and IgG levels are not only involved in the occurrence of NIP, but also in its progression, and thus their levels become abnormal with the occurrence of NIP, and gradually return to normal with the improvement of the condition of the children with NIP, and they have the functions of diagnosing the occurrence of NIP and evaluating the therapeutic efficacy of NIP, which provides more evidence for the clinicians in the diagnosis of NIP and the evaluation of the antibacterial treatment effect of NIP patients. This provides more evidence for clinicians to diagnose NIP and evaluate the effectiveness of antimicrobial therapy in children with NIP. NIP requires rapid antibiotic treatment after diagnosis, but clinical outcomes are poor when the etiology is unclear and pathogenesis is limited [22] . The lack of specific clinical symptoms in the early stage of newborns with NIP, and the bacterial culture is the gold standard for NIP diagnosis, but it is time-consuming and has a low positivity rate, whereas the pathogenicity diagnosis lags behind, which is detrimental to the treatment of NIP. In this study, the pathogenic bacteria isolated from the experimental group included bacteria, virus and mycoplasma, and the latter two were mostly mixed, so virus and mycoplasma infections were combined into the non-bacterial infection group, and simple bacterial infections were set up as bacterial infections group, and significant differences in the levels of serum Hb, LAC, and IgM between the two groups were found, and ROC curves were drawn to find out that they had discriminatory diagnostic efficacy in the types of NIP infections. Further, the ROC curve was plotted and found to be effective in identifying the type of NIP infection. This is because IgM antibody is the earliest to appear in humoral immunity and is a diagnostic marker for acute lung infections, and it has been proved that bacterial lipopolysaccharide, polymerized flagellin and other thymus-independent antigens do not have antigenic determinants, and they are unable to activate helper T-cells, and they do not need the assistance of T-cells to stimulate B-cells to produce antibodies, and they can only activate B-cells to produce IgM, but not to convert to IgG. It does not cause cellular immunity and has no immune memory [23] . The abnormal decrease of Hb level in the bacterial infection group and the abnormal increase of LAC in the non-bacterial infection group are consistent with the results of Han Fan et al [24] , which shows that both of them can be used as serological factors to identify the type of NIP infections, but their intrinsic mechanisms are still unclear and need to be further studied. In conclusion, serum Hb, LAC, IgA, IgM and IgG levels can be used to assess the efficacy of NIP, and among them, Hb, LAC and IgM can be used as a new factor to identify the type of NIP infection, which is helpful for clinicians to make early diagnosis of NIP and its type of infection, and to accurately assess the efficacy of antibiotic treatment. There are some shortcomings in this study, such as the small sample size and the lack of in-depth analysis of the intrinsic relationship between Hb and LAC to identify the type of NIP infection, etc. These will be improved in the next study. Declarations Project funding ： The clinical value of Hb, lactate, and immunoglobulin levels in neonatal infectious。Number: gzwkj2022-138 Acknowledgments We thank all the colleagues and students who participated in this study and everyone who helped with this project. We express our sincere gratitude to the Guizhou Provincial Health Commission and the Zunyi First People's Hospital for providing financial support. Author contributions Pinglin Zhang and Xin Zhao were responsible for designing the experiments and experimental manipulations. Declaration of interests The authors declare no competing interests. Data availability Further information and requests for resources and reagents should be directed to and will be fulfilled by the lead contact, Pinglin Zhang ( [email protected] ). Any further requests for resources and reagents should be fulfilled and will be directed to the lead contact, Pinglin Zhang ( [email protected] ). 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1","display":"","copyAsset":false,"role":"figure","size":186240,"visible":true,"origin":"","legend":"\u003cp\u003eROC curves of serum Hb, LAC and immunoglobulin IgM levels to diagnose the type of NIP infection.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7353556/v1/8a82570803845bc42f4e7732.png"},{"id":93013188,"identity":"94594ab4-7d6d-4272-90fc-60176b047ac8","added_by":"auto","created_at":"2025-10-08 07:24:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":240023,"visible":true,"origin":"","legend":"\u003cp\u003eROC curves of serum Hb, LAC and immunoglobulin levels for the diagnosis of NIP efficacy.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7353556/v1/25430f130510bd32722d6894.png"},{"id":93013192,"identity":"857290fc-2ab3-4935-952e-1fbc8a0ba13e","added_by":"auto","created_at":"2025-10-08 07:24:09","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":107007,"visible":true,"origin":"","legend":"\u003cp\u003eThe secretion of serum Hb, LAC and immunoglobulin IgM levels for normal newborn and diagnosis of NIP.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7353556/v1/68b83a88ceecf585798f13e7.png"},{"id":93013146,"identity":"e063ba5d-e8a9-41d0-949e-e870c03a21d3","added_by":"auto","created_at":"2025-10-08 07:24:04","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":71335,"visible":true,"origin":"","legend":"\u003cp\u003eThe expression of proteins (IgA, IgM and IgG) for normal newborn and diagnosis of NIP.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7353556/v1/a53a3c80e0532a76ace7479f.png"},{"id":93014684,"identity":"3c7f76c2-9dc8-4d14-9004-c2f5f25bd3ed","added_by":"auto","created_at":"2025-10-08 07:40:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1045139,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7353556/v1/5203cbdb-dfb9-4bff-832a-33cbc362a675.pdf"},{"id":93013187,"identity":"70a46b13-4334-4352-96af-814ed6f979b3","added_by":"auto","created_at":"2025-10-08 07:24:08","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":46870,"visible":true,"origin":"","legend":"","description":"","filename":"DataUpdated.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7353556/v1/3d5d8e966d19b4076cc26c28.xlsx"},{"id":93013158,"identity":"f10e9ba5-defc-4b43-bb2a-8350f75616d8","added_by":"auto","created_at":"2025-10-08 07:24:05","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1492920,"visible":true,"origin":"","legend":"","description":"","filename":"Projectfunding.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7353556/v1/fe44af30fdd889c5591cb540.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Combined detection in type identification and curative effect evaluation of neonatal infectious pneumonia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNeonatal Infectious pneumonia (NIP) is the most common infectious disease in the neonatal period. Neonates with weak immune system are susceptible to bacterial, viral and other pathogenic microorganisms, and the onset of NIP can lead to respiratory distress, fever, coughing and wheezing, and in severe cases, shock or even death, which is the main cause of neonatal mortality. Therefore, rapid identification of the type of NIP infection and effective treatment is the key to improving neonatal survival and treatment outcome\u003csup\u003e[1]\u003c/sup\u003e. However, the lack of specific signs and clinical symptoms in the early stage of NIP, culture, isolation and identification of pathogenic microorganisms are the gold standard for determining the type of NIP in neonates, but the test results are often lagging behind the clinical use of medication, resulting in the emergence of drug-resistant strains and poor therapeutic effects. Therefore, exploring new and reliable methods for identifying NIP types is a prerequisite for targeted antibiotic application and improvement of therapeutic efficacy. Domestic studies have shown that infection alters the human hematopoietic microenvironment, which is associated with iron deficiency anemia\u003csup\u003e[2]\u003c/sup\u003e. Overseas studies have found that a decrease in hemoglobin (Hb) levels in a short period of time after pneumonia diagnosis may be a predictive indicator of the deterioration of pneumonia in patients with COVID-19, and it has been postulated that hemoglobin Hb may be involved in the occurrence and development of NIP\u003csup\u003e[3]\u003c/sup\u003e. Lactic acid (LAC) is widely found in human and animal metabolic processes, and is an important indicator of blood perfusion and cellular hypoxia. It showed that its expression level in serum is closely related to the disease status of pneumonia patients\u003csup\u003e[4]\u003c/sup\u003e.\u0026nbsp;Immunoglobulin, as a major component of the body's humoral immune response, is a common indicator for assessing individual immune status\u003csup\u003e[5, 6]\u003c/sup\u003e. Studies have reported increasing inflammation and altered immune status in children with NIP, and modulation of immune function may improve the condition, especially immunoglobulin M (IgM), which is significantly altered in pediatric pneumonia. Therefore, the present study attempted to analyze the changes and clinical significance of serum Hb, LAC and IgM levels in children with NIP to provide new diagnostic factors for early targeted antimicrobial therapy in newborns with NIP.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Information and methodology","content":"\u003cp\u003eAll methods were carried out in accordance with relevant guidelines and regulations; all experimental protocols were approved by the Ethics Committee of Zunyi First People\u0026apos;s Hospital and the relevant licensing committees; informed consent was also obtained from all legal guardians of the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1\u0026nbsp;General information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom\u0026nbsp;January\u0026nbsp;2022 to\u0026nbsp;December\u0026nbsp;2022, 80 hospitalized children diagnosed with NIP were included in the experimental group. Inclusion criteria: (1) full-term delivery of newborns (age 0-28 days); (2) a history of exposure to respiratory infections, respiratory tract infection symptoms, lung signs, chest X-rays showed pneumonia features, in line with the diagnostic criteria of NIP\u003csup\u003e[7]\u003c/sup\u003e; (3) the clinical data is complete, and the supervisor signed the informed consent form. Exclusion criteria: (1) concurrent with other infectious diseases; (2) received relevant treatment before enrollment; (3) concurrent with other lung diseases, congenital anomalies, genetic and metabolic diseases, etc.; (4) history of immunoglobulin, hormone and immunosuppressant application. In the same period, 40 healthy children were selected from the child health care clinic for health examination in the ratio of 2:1 by age and gender, and their general information such as age and gender were complete in the control group. There was no statistically significant difference between the general information of the two groups (P\u0026gt;0.05), see Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1. Comparison of general information of newborns in experimental and control groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003egroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSex (male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGestational\u0026nbsp;age (weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBirth weight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eExperimental group 80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37.96\u0026plusmn;1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.45\u0026plusmn;3.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.64\u0026plusmn;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eControl\u0026nbsp;group\u0026nbsp;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.05\u0026plusmn;1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.98\u0026plusmn;3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.61\u0026plusmn;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eT/\u0026chi;\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.264\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Methodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDetection method：A 5mL venous blood sample was collected from both groups of newborns on the morning of the next day after hospitalization on an empty stomach, and the serum was immediately separated within 0.5 min and stored in a refrigerator at -20℃ for 15 min. Hb and LAC were measured by Gem Premier 3000 blood gas analyzer, and serum IgG, IgA and IgM levels were measured by automatic biochemical analyzer. The normal values of the above indexes for newborns ranged from 110 to 160 g/L for Hb, 0.5 to 1.6 mmol/L for LAC, 7 to 16 g/L for serum IgG, 0.7 to 4 g/L for IgA and 0.7 to 2.3 g/L for IgM.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTreatment and efficacy evaluation：Newborns in the experimental group were treated routinely, including antibiotic treatment according to the drug sensitivity test, maintaining sufficient temperature and humidity, rehydration, correcting electrolyte disorders and acid-base balance, supplying oxygen to those with respiratory distress, keeping the airway open, and injecting human immunoglobulin intravenously if necessary. The efficacy of the treatment was observed in 5 days, and the newborns were regarded as effective if the symptoms of respiratory distress and cyanosis disappeared, the symptoms of coughing, wheezing, and wet rhonchi of the lungs were significantly improved, and the newborns did not have any choking, spitting up, fever, or weakness of heart, and their urine and feces were normal and their blood gas indexes were normal or basically normal; and the newborns who failed to meet the above criteria were considered to be ineffective.\u003c/p\u003e\n\u003cp\u003eGrouping：The experimental group was divided into 49 cases in the bacterial pneumonia group and 31 cases in the non-bacterial pneumonia group according to the results of pathogenetic analysis. The experimental group was divided into 58 cases in the NIP effective group and 22 cases in the NIP ineffective group according to the effect of NIP treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3\u0026nbsp;Statistical methods\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data of this experiment were analyzed using SPSS24.0 statistical software, and the measurement data were expressed as mean \u0026plusmn; standard deviation (x\u0026plusmn;s), and the t-test of independent samples was conducted to compare the two groups. Count data were expressed as the number of cases n, and x\u0026sup2; test was adopted. The diagnostic value was obtained by plotting the Receiver operating characteristic curve (ROC) curve to obtain the AUC, 95% confidence interval, sensitivity, specificity and cut-off value. p\u0026lt;0.05 means that the difference is statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eComparison of serum Hb, LAC and immunoglobulin levels between the experimental group and the control group Compared with the control group, the experimental group had lower serum Hb levels and higher LAC and immunoglobulin levels of IgG, IgA, and IgM, and the differences were statistically significant (P\u0026lt;0.05), as shown in Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2 Neonatal testing indicators in experimental and control groups (x\u0026plusmn;s)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003egroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eHb(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eLAC\u0026nbsp;(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eIgG\u0026nbsp;(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eIgA(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eIgM(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eExperimental group 80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e152.69\u0026plusmn;16.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1.87\u0026plusmn;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e16.39\u0026plusmn;3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4.41\u0026plusmn;1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e2.72\u0026plusmn;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eControl\u0026nbsp;\u003c/p\u003e\n \u003cp\u003egroup\u0026nbsp;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e167.75\u0026plusmn;17.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1.41\u0026plusmn;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e12.46\u0026plusmn;3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2.69\u0026plusmn;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e1.79\u0026plusmn;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e4.629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4.542\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5.792\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e7.642\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eComparison of serum Hb, LAC and immunoglobulin levels in children with different types of NIP infection revealed that serum Hb levels were lower in the bacterial pneumonia group, while LAC and IgM levels were higher (P\u0026lt;0.05), and the difference between IgA and IgG groups was not statistically significant (P\u0026gt;0.05), as shown in Table 3.\u003c/p\u003e\n\u003cp\u003eTable 3 Serum Hb, LAC and immunoglobulin levels (x\u0026plusmn;s) in children with different types of infection in NIP.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003egroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eHb(g/L)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eLAC\u0026nbsp;(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eIgG(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eIgA(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eIgM(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eBacterial pneumonia group\u0026nbsp;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e149.53\u0026plusmn;16.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.69\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e16.32\u0026plusmn;3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e4.39\u0026plusmn;1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e2.91\u0026plusmn;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eNon-bacterial pneumonia group\u0026nbsp;62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e157.68\u0026plusmn;15.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2.17\u0026plusmn;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e16.51\u0026plusmn;3.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e4.45\u0026plusmn;1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e2.44\u0026plusmn;0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e2.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e2.928\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eComparison of serum Hb, LAC and immunoglobulin levels between the NIP effective group and the NIP ineffective group Compared, the NIP effective group had a higher level of serum Hb, and a lower level of LAC, IgG, IgA, and IgM, and the differences were statistically significant (P\u0026lt;0.05), as shown in Table 4.\u003c/p\u003e\n\u003cp\u003eTable 4 Comparison of serum Hb, LAC and immunoglobulin levels in those with different clinical outcomes of NIP (x\u0026plusmn;s)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003egroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eHb(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eLAC\u0026nbsp;(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eIgG(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eIgA(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eIgM(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eNIP active\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGroup\u0026nbsp;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e163.54\u0026plusmn;18.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.59\u0026plusmn;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e13.72\u0026plusmn;3.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e2.65\u0026plusmn;0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e1.65\u0026plusmn;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eNIP Invalid Group\u0026nbsp;57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e151.15\u0026plusmn;20.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.97\u0026plusmn;0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e17.04\u0026plusmn;3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3.12\u0026plusmn;0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e2.37\u0026plusmn;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2.591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e3.532\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e3.558\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e5.724\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eROC curves were used to analyze the diagnostic efficacy of serum Hb, LAC and immunoglobulin IgM levels in the diagnosis of NIP infection types. The AUCs of serum Hb, LAC and IgM for differential diagnosis of NIP infection types were 0.647, 0.732 and 0.698, respectively, and the AUC for the combined diagnosis of the three was 0.818, which was higher than that of a single factor (P\u0026lt;0.05 for all three factors), as shown in Table 5 and Figure 1.\u003c/p\u003e\n\u003cp\u003eTable 5 Diagnostic efficacy of serum Hb, LAC and immunoglobulin IgM levels on the type of NIP infection\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eserum factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e95% confidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003eSensitivity (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eSpecificity (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003ecut-off value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eHb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.533-0.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e69.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e70.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026le;153.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eLAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.622-0.825\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e69.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e74.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026le;1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eIgM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.585-0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e40.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e96.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eunite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0.732-0.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e83.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e67.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eROC curves were used to analyze the diagnostic efficacy of serum Hb, LAC and immunoglobulin levels for NIP efficacy. The AUCs of serum Hb, LAC, IgG, IgA and IgM for single and combined diagnosis of NIP efficacy were 0.696, 0.676, 0.751, 0.603, 0.825, and 0.912 in the following order, and the combined diagnosis method was higher than that of single diagnosis (P\u0026lt;0.05), as shown in Table 6 and Figure 2.\u003c/p\u003e\n\u003cp\u003eTable 6 Diagnostic efficacy of serum Hb, LAC and immunoglobulin levels for NIP efficacy\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eserum factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e95% confidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eSensitivity (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eSpecificity (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003ecut-off value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eHb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.583-0.794\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e60.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e81.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026gt;161.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eLAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.562-0.776\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e98.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e45.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026le;2.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eIgG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.642-0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e79.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e68.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026le;16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eIgA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.487-0.711\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e98.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e40.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026le;3.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eIgM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.825\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.724-0.901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e75.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e77.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026le;1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eunite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.828-0.964\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e93.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e81.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAt the same time, the concentration of Hb, LAC, IgG, IgA and IgM in the blood of NIP patients was detected by ELISA. The results showed that the concentration of Hb, LAC, IgG, IgA and IgM in NIP patients much higher than that in normal newborns (P\u0026lt;0.05), as shown in Figure 3.\u003c/p\u003e\n\u003cp\u003eIt was collected the serum of the patients and detected the serum protein expression of IGA by western blot assay. And we found that the trend was consistent with the ELISA results, the expression of IgA, IgM and IgG levels of Hb in NIP patients much higher than that in normal newborns, as shown in Figure 4.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe pathogen of NIP mainly originates from vertical transmission from mother to child and respiratory colonisation, and because of the low immunity of newborns, it is easy to develop into a serious infection, which should be diagnosed and treated in a timely manner\u003csup\u003e[1, 8]\u003c/sup\u003e. Currently, pneumonia is mainly diagnosed by symptoms such as cough, shortness of breath and chest X-ray findings, but the cough reflex of neonates has not been fully formed, the respiratory muscles are weak, coupled with the lung signs are often not obvious in the early stage, it is easy to ignore and delay treatment, increasing the risk of death, and therefore, exploring new diagnostic methods is very necessary.\u003c/p\u003e\n\u003cp\u003eIn recent years, serological tests have attracted much attention because of their simplicity, low cost, rapidity, safety and other advantages, and have been used in the etiological diagnosis of NIP with certain results\u003csup\u003e[9]\u003c/sup\u003e. In this study, serum Hb, LAC and immunoglobulin were selected as the diagnostic factors of NIP. Table 1 shows that the serum Hb level of the experimental group was lower than that of the control group, and the levels of LAC, IgG, IgA and IgM were higher than those of the control group, suggesting that the newborns with NIP may have a reduced serum Hb, an elevated LAC and immunoglobulin level, and that the five serological factors mentioned above may have a role in the diagnosis of NIP. The reason for this analysis is that Hb is one of the indicators for clinically assessing the nutritional status of the organism and determining whether there is anemia or not, and foreign studies have found that there is a certain correlation between anemia and viral infections in children\u003csup\u003e[10-12]\u003c/sup\u003e. Anemia is easy to occur in severe infections, and after the anemia reaches a certain level, the oxygen transport capacity of blood decreases, and insufficient oxygen supply may damage tissues and organs\u003csup\u003e[13]\u003c/sup\u003e. However, due to the slow development of anemia and the seriousness of NIP symptoms, anemia is often overlooked, resulting in the complication of NIP, prolonging hospital stay and even affecting the prognosis. Traditionally, elevated LAC is thought to be caused by the accumulation of hypoxia in the body, but in fact, high levels of LAC are also associated with infections in the body: NIP patients have reduced enzyme activity, insufficient perfusion of organs and tissues, hypoxia in lung tissue cells, and reduced mitochondrial oxygen transport, resulting in elevated levels of serum LAC; and when the lungs are damaged in NIP, the rate of fibrin conversion is accelerated, resulting in the body's release of even more LAC\u003csup\u003e[14, 15]\u003c/sup\u003e. Serum LAC has been recognized as a biomarker for the prognosis of sepsis, and foreign animal experiments have proved that high lactate cycle level is related to the severity of sepsis and mortality\u003csup\u003e[16]\u003c/sup\u003e. As the theory of the immune function of infection becomes more and more perfect, medical workers realize that the pathological changes that occur after microorganisms such as bacteria, viruses and mycoplasma infect the cells of the organism are a complex process, and that the balance of the acquired immunity of the host determines the occurrence of the infection and the regression of the infection\u003csup\u003e[17, 18]\u003c/sup\u003e. Immunoglobulins (IgA, IgM, IgG) are indicators of humoral immunity in neonates, which mainly protect the organism through antibodies produced by effector B cells, among which IgA plays the role of an immunity barrier in the mucous membrane of epithelial cells of neonates' respiratory tracts, and its level may be abnormally elevated in the event of respiratory tract infections in neonates; IgM has an anti-infective effect, and it can stimulate complement, whose concentration increases sharply in the peripheral blood after an infection; IgG has an anti-infective effect, and can stimulate complement, whose concentration increases sharply in the peripheral blood after an infection. IgM has an anti-infective effect and can activate complement, and its concentration in peripheral blood increases sharply after infection; IgG is a neutralizing agent that also activates complement, and its level can be increased gradually after infection to clear pathogens\u003csup\u003e[19-21]\u003c/sup\u003e. In addition, according to Table 4 and Figure 2, the above five serological factors can also be used to assess the efficacy of NIP, and the AUC of the combination of these factors is 0.912, which shows that the combination of these factors is highly effective in diagnosing the efficacy of NIP. In view of the above, serum Hb, LAC, IgA, IgM and IgG levels are not only involved in the occurrence of NIP, but also in its progression, and thus their levels become abnormal with the occurrence of NIP, and gradually return to normal with the improvement of the condition of the children with NIP, and they have the functions of diagnosing the occurrence of NIP and evaluating the therapeutic efficacy of NIP, which provides more evidence for the clinicians in the diagnosis of NIP and the evaluation of the antibacterial treatment effect of NIP patients. This provides more evidence for clinicians to diagnose NIP and evaluate the effectiveness of antimicrobial therapy in children with NIP.\u003c/p\u003e\n\u003cp\u003eNIP requires rapid antibiotic treatment after diagnosis, but clinical outcomes are poor when the etiology is unclear and pathogenesis is limited\u003csup\u003e[22]\u003c/sup\u003e. The lack of specific clinical symptoms in the early stage of newborns with NIP, and the bacterial culture is the gold standard for NIP diagnosis, but it is time-consuming and has a low positivity rate, whereas the pathogenicity diagnosis lags behind, which is detrimental to the treatment of NIP. In this study, the pathogenic bacteria isolated from the experimental group included bacteria, virus and mycoplasma, and the latter two were mostly mixed, so virus and mycoplasma infections were combined into the non-bacterial infection group, and simple bacterial infections were set up as bacterial infections group, and significant differences in the levels of serum Hb, LAC, and IgM between the two groups were found, and ROC curves were drawn to find out that they had discriminatory diagnostic efficacy in the types of NIP infections. Further, the ROC curve was plotted and found to be effective in identifying the type of NIP infection. This is because IgM antibody is the earliest to appear in humoral immunity and is a diagnostic marker for acute lung infections, and it has been proved that bacterial lipopolysaccharide, polymerized flagellin and other thymus-independent antigens do not have antigenic determinants, and they are unable to activate helper T-cells, and they do not need the assistance of T-cells to stimulate B-cells to produce antibodies, and they can only activate B-cells to produce IgM, but not to convert to IgG. It does not cause cellular immunity and has no immune memory\u003csup\u003e[23]\u003c/sup\u003e. The abnormal decrease of Hb level in the bacterial infection group and the abnormal increase of LAC in the non-bacterial infection group are consistent with the results of Han Fan et al \u003csup\u003e[24]\u003c/sup\u003e, which shows that both of them can be used as serological factors to identify the type of NIP infections, but their intrinsic mechanisms are still unclear and need to be further studied.\u003c/p\u003e\n\u003cp\u003eIn conclusion, serum Hb, LAC, IgA, IgM and IgG levels can be used to assess the efficacy of NIP, and among them, Hb, LAC and IgM can be used as a new factor to identify the type of NIP infection, which is helpful for clinicians to make early diagnosis of NIP and its type of infection, and to accurately assess the efficacy of antibiotic treatment. There are some shortcomings in this study, such as the small sample size and the lack of in-depth analysis of the intrinsic relationship between Hb and LAC to identify the type of NIP infection, etc. These will be improved in the next study.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eProject funding\u003c/strong\u003e：\u003c/p\u003e\n\u003cp\u003eThe clinical value of Hb, lactate, and immunoglobulin levels in neonatal infectious。Number: gzwkj2022-138\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the colleagues and students who participated in this study and everyone who helped with this project. We express our sincere gratitude to the Guizhou Provincial Health Commission and the Zunyi First People's Hospital for providing financial support.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePinglin Zhang and Xin Zhao were responsible for designing the experiments and experimental manipulations.\u003c/p\u003e\n\u003ch3\u003eDeclaration of interests\u003c/h3\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFurther information and requests for resources and reagents should be directed to and will be fulfilled by the lead contact, Pinglin Zhang ([email protected]). Any further requests for resources and reagents should be fulfilled and will be directed to the lead contact, Pinglin Zhang ([email protected]).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e SUN Q, GAO Y, QIAO L, et al. 25(OH)-Vitamin D alleviates neonatal infectious pneumonia via regulating TGFbeta-mediated nuclear translocation mechanism of YAP/TAZ [J]. Bioengineered, 2021, 12(1): 8931-42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e ZHANG M, HUANG X, SONG M, et al. A novel LC-MS/MS method for the simultaneous analysis of selected fat-soluble vitamins in serum obtained from pediatric patients with pneumonia [J]. Anal Methods, 2022, 14(25): 2511-21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e ANAI M, AKAIKE K, IWAGOE H, et al. Decrease in hemoglobin level predicts increased risk for severe respiratory failure in COVID-19 patients with pneumonia [J]. 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Am J Trop Med Hyg, 2021, 104(3): 1003-12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e ODHIAMBO C, ZEH C, ONDOA P, et al. Anemia and Red Blood Cell Abnormalities in HIV-Infected and HIV-Exposed Breastfed Infants: A Secondary Analysis of the Kisumu Breastfeeding Study [J]. PLoS One, 2015, 10(11): e0141599.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e PENDA C I, MOUKOKO E C E, NOLLA N P, et al. Malnutrition among HIV infected children under 5 years of age at the Laquintinie hospital Douala, Cameroon [J]. Pan Afr Med J, 2018, 30: 91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e ZHONG Q, ZENG J, LIN T, et al. The detection, treatment of parvovirus B19 infection induced anemia in solid organ transplants: A case series and literature review of 194 patients [J]. Transfus Clin Biol, 2022, 29(2): 168\u0026thinsp;\u0026minus;\u0026thinsp;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e LU Y, SONG L. Clinical Significance of Procalcitonin, Lactic Acid, and Endotoxin Testing for Children With Severe Pneumonia and Sepsis [J]. Altern Ther Health Med, 2023, 29(3): 218\u0026thinsp;\u0026minus;\u0026thinsp;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e RUAN P, GONG Z J, ZHANG Q R. Changes of plasma D(-)-lactate, diamine oxidase and endotoxin in patients with liver cirrhosis [J]. Hepatobiliary Pancreat Dis Int, 2004, 3(1): 58\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e YANG K, FAN M, WANG X, et al. Lactate promotes macrophage HMGB1 lactylation, acetylation, and exosomal release in polymicrobial sepsis [J]. Cell Death Differ, 2022, 29(1): 133\u0026thinsp;\u0026minus;\u0026thinsp;46.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e BAUMLER A J. Infection and Immunity Welcomes the New Microbiology [J]. Infect Immun, 2017, 85(7).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e ZOUBOULIS C C, BENHADOU F, BYRD A S, et al. What causes hidradenitis suppurativa ?-15 years after [J]. Exp Dermatol, 2020, 29(12): 1154-70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e NUCCETELLI M, PIERI M, GISONE F, et al. Combined anti-SARS-CoV-2 IgA, IgG, and IgM Detection as a Better Strategy to Prevent Second Infection Spreading Waves [J]. Immunol Invest, 2022, 51(2): 233\u0026thinsp;\u0026minus;\u0026thinsp;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e IOANNIDIS J P A. Infection fatality rate of COVID-19 inferred from seroprevalence data [J]. Bull World Health Organ, 2021, 99(1): 19-33F.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e SEMMLER G, TRAUGOTT M T, GRANINGER M, et al. Assessment of S1-, S2-, and NCP-Specific IgM, IgA, and IgG Antibody Kinetics in Acute SARS-CoV-2 Infection by a Microarray and Twelve Other Immunoassays [J]. J Clin Microbiol, 2021, 59(5).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e DINH A, ROPERS J, DURAN C, et al. Discontinuing beta-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial [J]. Lancet, 2021, 397(10280): 1195\u0026thinsp;\u0026minus;\u0026thinsp;203.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e KYVELIDOU C, SOTIRIOU D, ZERVA I, et al. Protection Against Lipopolysaccharide-Induced Immunosuppression by IgG and IgM [J]. Shock, 2018, 49(4): 474\u0026thinsp;\u0026minus;\u0026thinsp;82.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e CAI J Y, YAN C Y, WANG X Q, et al. [Clinical characteristics and risk factors for bronchoscopic airway mucus hypersecretion in childhood pneumonia infected by different pathogens] [J]. Zhonghua Er Ke Za Zhi, 2023, 61(8): 719\u0026thinsp;\u0026minus;\u0026thinsp;25.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hemoglobin, Lactic acid, Immunoglobulin, Neonate, Infectious pneumonia","lastPublishedDoi":"10.21203/rs.3.rs-7353556/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7353556/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To explore the significance of combined detection of serum hemoglobin (Hb), lactic acid (LAC) and immunoglobulin in the differential diagnosis and curative evaluation of neonatal infectious pneumonia (NIP).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: From January 2022 to December 2022, 80 hospitalized children with neonatal infectious pneumonia were selected as the experimental group, which were divided into bacterial pneumonia and non-bacterial pneumonia groups according to the results of the etiological analysis. Meanwhile, 40 healthy children from child health clinics were selected as the control group according at a ratio of 2:1 based on age and sex. The children in the experimental group received appropriate antibiotic treatment, fasting venous blood was collected before and after treatment, and serum Hb, LAC and immunoglobulin (IgG, IgA, IgM) levels were measured. The serum Hb, LAC and immunoglobulin levels were compared between the experimental and control groups. To compare serum Hb, LAC and immunoglobulin levels between the experimental and non-bacterial pneumonia groups. To compare serum Hb, Lactoferrin and Immunoglobulin levels before and after treatment in the experimental group. To plot the receiver operating characteristic curve (ROC) and analyze the diagnostic efficacy of the serum Hb, lactoferrin and immunoglobulin in differentiating the type of neonatal infectious pneumonia and evaluating the efficacy of treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Compared to the control group, newborns in the experimental group had lower levels of serum Hb and higher levels of immunoglobulin G (IgG), IgA and IgM (P\u0026lt;0.05). Compared to the non-bacterial pneumonia group, the bacterial pneumonia group had lower levels of serum Hb, LAC and higher levels of IgM (P\u0026lt;0.05), and the differences between the IgA and IgG groups were not statistically significant (P\u0026gt;0.05). Serum Hb levels were higher and LAC, IgG, IgA and IgM levels were lower (P\u0026lt;0.05) in the NIP effective group than in the NIP ineffective group. The AUCs of serum Hb, LAC and IgM for the differential diagnosis of NIP infection types were 0.647, 0.732 and 0.698 respectively, and the AUC for the combined diagnosis of the three was 0.818, which was higher than that of a single factor (P\u0026lt;0.05). The AUCs of serum Hb, LAC, IgG, IgA and IgM for single diagnosis of NIP were 0.696, 0.676, 0.751, 0.603, 0.825, and the AUC of the combined diagnosis was 0.912, which was higher than that of a single diagnosis (P\u0026lt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Serum Hb, LAC and immunoglobulin levels of IgG, IgA and IgM can be used to assess the efficacy of NIP, Hb, LAC and IgM can also be used to identify the type of NIP infection, and the combined diagnosis has the highest clinical value.\u003c/p\u003e","manuscriptTitle":"Combined detection in type identification and curative effect evaluation of neonatal infectious pneumonia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 07:23:36","doi":"10.21203/rs.3.rs-7353556/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"de5d28ca-03d6-4efc-8e02-09d1e98c3103","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55864637,"name":"Health sciences/Diseases"},{"id":55864638,"name":"Health sciences/Health care"},{"id":55864639,"name":"Health sciences/Medical research"},{"id":55864640,"name":"Biological sciences/Microbiology"}],"tags":[],"updatedAt":"2025-10-08T07:24:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 07:23:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7353556","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7353556","identity":"rs-7353556","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}