Analysis of TREC and KREC levels in premature newborns, taking into account gestational age, chorionicity, specific complications of the antenatal period and the presence of infectious and inflammatory diseases in the early neonatal period

• Mariia V. Pavlichenko
• Natalia V. Kosovtsova
• Tatiana V. Chumarnaya
• Dmitry A. Cheremokhin
• Mikhail A. Bolkov
• Olga E. Solovyova

Abstract

High rates of perinatal morbidity and mortality in complicated multiple pregnancies make it important for medical conditions to further research for markers of adverse outcomes.

Objective. To study the content of TREC and KREC molecules in premature newborns due to the gestational age, chorionicity, specific complications of the antenatal period (twin-twin transfusion syndrome, selective fetal growth restriction), and the presence of infections and inflammatory diseases in pregnant women and newborns. General blood test indicators and other biomarkers of infection and inflammatory diseases on the 7^th day of life were researched.

Material and methods. A single-center cross-sectional study of premature infants 7 days old (144–168 h of life) was conducted based on the Ural Research Institute of Maternity and Child Care, Ministry of Health of the Russian Federation, Yekaterinburg, during the period from 01.01.2023 till 20.12.2023.

The study involved 435 premature newborns of gestational age (25/0–36/6 weeks). The main group consists of 120 monochorionic twins (n=120). Patients of the main group were divided depending on complications of the antenatal period: newborns with twin-twin transfusion syndrome (n=30; 15 pairs), selective fetal growth restriction syndrome (n=40; 20 pairs), and without complications of intrauterine development (n=50; 25 pairs). The comparison group (n=315) was represented by newborns from singleton pregnancies (n=247) and chorionic twins (n=68).

All children underwent immunological screening with quantitative determination of TRECs and KRECs DNA using real-time polymerase chain reaction. The set of reagents “Immuno-BiT” (ABV-test, Russian Federation) was used.

Statistical processing of the material was performed in SPSS 27.0 using nonparametric criteria. Differences were considered statistically significant at p<0.05.

Results. In premature newborns of gestational age 25/0–31/6 weeks, significantly low levels of TREC were detected, indicating suppression of T-cell immunity (p<0.0001). In dichorionic premature twins 25/0–36/6 weeks of gestational age, a statistically significant increase in the number of KRECs was observed, which characterizes the activation of B-cell immunity (p<0.05). In the complicated course of monochorionic multiple pregnancies, immune features were diagnosed: after undergoing feto-fetal transfusion syndrome – a decrease of TRECs DNA (p=0.039), and against the background of selective fetal growth restriction – an increase in the level of KREC (p=0.032). An inverse correlation was determined between the pregnancy disease “Urinary tract infection with bacteriuria” and the KREC content in MH twins (r= -0.267; p=0.003). A negative correlation was revealed between the number of TREC and KREC molecules in MH twins on the 7^th day of life, the presence of various infections and inflammatory diseases in the early neonatal period, and the content of segmented neutrophils (%, abs.), as well as a positive correlation between TREC levels and the number lymphocytes (%, abs.).

Conclusion. The level of TREC in monochorionic twins depends on gestational age and the presence of specific complications of the antenatal period (twin-twin transfusion syndrome and selective fetal growth restriction) must be taken into account when interpreting the results of expanded neonatal screening.

Keywords: monochorionic diamniotic twins; TREC; KREC, feto-fetal transfusion syndrome; selective fetal growth restriction; “Immuno-BiT”

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