Mannose-binding lectin gene polymorphism and its effect on short term outcomes in preterm infants

Dogan, Pelin; Ozkan, Hilal; Koksal, Nilgun; Oral, Haluk Barbaros; Bagci, Onur; Guney Varal, Ipek

doi:10.1016/j.jped.2019.03.001

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Original articles • J. Pediatr. (Rio J.) 96 (4) • Jul-Aug 2020 • https://doi.org/10.1016/j.jped.2019.03.001 copy

Mannose-binding lectin gene polymorphism and its effect on short term outcomes in preterm infants^☆ ☆ Please cite this article as: Dogan P, Ozkan H, Koksal N, Oral HB, Bagci O, Guney Varal I. Mannose-binding lectin gene polymorphism and its effect on short term outcomes in preterm infants. J Pediatr (Rio J). 2020;96:520-6.

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Abstract

Objective:

Mannose-binding lectin, which belongs to the collectin family, is an acute-phase reactant that activates the complement system. This study aimed to investigate the effect of MBL2 gene polymorphism on short-term outcomes in preterm infants.

Method:

Infants of <37 gestational weeks who were admitted to the neonatal intensive care unit during a two-year period were enrolled in this prospective study. The neonates were categorized into two groups according to their MBL2 genotypes. Normal MBL2 genotype was defined as MBL2 wild-type (AA genotype), whereas mutant MBL2 genotype was defined as MBL2 variant-type (AO/OO genotype). The relationship between MBL2 genotype and short-term morbidity and mortality was evaluated.

Results:

During the two-year study period, 116 preterm infants were enrolled in this study. In MBL2 variant-type, mannose-binding lectin levels were significantly lower and incidences of mannose-binding lectin deficiency (MBL level < 700 ng/mL) were higher (p < 0.001). In this group, the prevalence of respiratory distress syndrome and mortality was significantly higher (p < 0.001, p = 0.03 respectively). In the MBL2 wild-type group, the prevalence of necrotizing enterocolitis (NEC) was higher (p = 0.01). Logistic regression analyses revealed that MBL2 variant-type had a significant effect on respiratory distress syndrome development (odds ratio, 5.1; 95% confidence interval, 2.2-11.9; p < 0.001).

Conclusions:

MBL2 variant-type and mannose-binding lectin deficiency are important risk factors for respiratory distress syndrome development in preterm infants. Additionally, there is an association between MBL2 wild-type and NEC. Further studies on this subject are needed.

KEYWORDS
Mannose-binding lectin; Preterm; Respiratory distress syndrome

	MBL2 wild-type	MBL2 variant -type	p
	(n = 69)	(n = 47)	p
GA at birth, median in weeks (range)	30 (29-33)	31 (29-33)	0.6^a a Mann-Whitney U test.
Birth weight, g (mean ± SD)	1539 ± 574	1459 ± 556	0.5^b b Student's t -test.
Sex, n (%)
Male	40 (58)	29 (62)
Female	29 (42)	18 (38)	0.7^c c Chi-squared test.
SGA, n (%)	13 (19)	14 (30)	0.1^c c Chi-squared test.
Cesarian delivery, n (%)	58 (84)	36(77)	0.3^c c Chi-squared test.
Apgar score, median (range)
Minute 1	7 (5-8)	6 (4-7)	0.1^a a Mann-Whitney U test.
Minute 5	8 (7-9)	8 (7-9)	0.1^a a Mann-Whitney U test.
Antenatal steroid, n (%)
None		33 (48)	30 (64)
Single course		18 (26)	9 (19)
Repeat course		18 (26)	8 (17)
Maternal preeclampsia, n (%)	17 (25)	15 (32)	0.4^c c Chi-squared test.
Maternal infection, n (%)	3 (4)	4 (9)	0.4^c c Chi-squared test.
PPROM, n (%)	13 (19)	6 (13)	0.4^c c Chi-squared test.
Chorioamnionitis, n (%)	4 (6)	2 (4)	0.7^c c Chi-squared test.
MBL levels, (ng/mL) median (range)	993 (257-1812)	10 (10-473)	<0.001 ^a a Mann-Whitney U test.
MBL deficiency, (MBL level <700 ng/mL), n (%)	30 (44)	45 (96)	<0.001 ^c c Chi-squared test.

	MBL2 wild-type(n = 69)	MBL2 variant-type(n = 47)	p ^a a Chi-squared test.
RDS, n (%)	21 (30)	31 (66)	<0.001
IVH, (Papile grade 3-4), n (%)	3 (4)	2 (4)	0.9
NEC, (>grade 1), n (%)	9 (13)	0 (0)	0.01
BPD, (grade 2-3), n (%)	16 (23)	6 (13)	0.2
ROP, (>stage 2), n (%)	10 (15)	3 (6)	0.2
LOS, n (%)	18 (26)	16 (34)	0.4
Mortality, n (%)	6 (9)	11 (23)	0.03

	MBL deficiency		Normal MBL >700 ng/mL ( n = 41)	p ^a a Chi-squared test.
	<150 ng/mL(n = 36)	150-700 ng/mL(n = 36)	Normal MBL >700 ng/mL ( n = 41)	p ^a a Chi-squared test.
RDS, n (%)	28 (72)	23 (64)	1 (3)	<0.001
IVH, (Papile grade 3-4), n (%)	2 (5)	1 (3)	2 (5)	0.7
NEC, (>grade 1), n (%)	0 (0)	1 (3)	8 (20)	0.002
BPD, (grade 2-3), n (%)	5 (13)	5 (14)	12 (29)	0.1
ROP, (>stage 2), n (%)	3 (8)	4 (11)	6 (15)	0.06
LOS, n (%)	14 (36)	10 (28)	10 (24)	0.5
Mortality, n (%)	7 (18)	7 (19)	3 (7)	0.3

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[1] * Corresponding author. E-mail: pelin_akbas@yahoo.com (P. Dogan).