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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica

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Volume 47, Issue 7


The value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) parameters in analysis with fetal malnutrition neonates

Emrah Can
  • Corresponding author
  • Associate Professor, Department of Pediatrics, Bagcilar Training and Research Hospital, Istanbul, Turkey
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Ceren Can
  • Department of Pediatric Immunology and Allergy, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2019-07-18 | DOI: https://doi.org/10.1515/jpm-2019-0016



To assess the association between fetal malnutrition (FM) and the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in singleton term appropriate for gestational age (AGA) neonates.


This cross-sectional observational study was performed with 4340 singleton, term AGA neonates without perinatal disease over a two-year period.


A total of 4320 neonates were evaluated in this study. Those diagnosed with fetal malnutrition, 284 (6%) neonates, were compared with 150 healthy term AGA neonates. Gestational week, birth weight, birth height, head circumference, maternal age, last pregnancy weight, and status of income of the FM group were found to be lower when compared to the control group (P = 0.011). Low last pregnancy weight (P = 0.017) and low level of income (P = 0.042) were found to be factors that affect the presence of FM. The NLR and PLR were found to be significantly higher in the FM group compared with term AGA healthy controls. In correlation analyses, there was a negative correlation between the NLR and PLR with fetal nutritional status (P = 0.011 and P < 0.001, respectively). When the NLR level was taken as 4.51, the sensitivity and specificity of the test for FM were calculated as 81.2% and 80.8%, respectively [area under the receiver-operating characteristic curve (AUROC): 0.81]; when the PLR level was taken as 155.4, the sensitivity and specificity of the test for FM were calculated as 87.0% and 85.4%, respectively (AUROC: 0.94).


Cord-blood NLR and PLR negatively correlate with term FM AGA neonates.

Keywords: fetal malnutrition; lymphocyte; neutrophil; platelet


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About the article

Corresponding author: Emrah Can, MD, Associate Professor, Department of Pediatrics, Bagcilar Training and Research Hospital, Istanbul, Turkey, Tel.: +90 532 512 36 06, Fax: +90 212 471 00 00

Received: 2019-01-16

Accepted: 2019-06-25

Published Online: 2019-07-18

Published in Print: 2019-09-25

Author contributions: Emrah Can: Substantial contributions to the conception and design of, or acquisition of data or analysis and interpretation of data, drafting the article and final approval of the version to be published. Ceren Can: Substantial contributions to the conception and design of, acquisition of data or analysis and interpretation of data, critical intellectual content, drafting the article and final approval of the version to be published. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Journal of Perinatal Medicine, Volume 47, Issue 7, Pages 775–779, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2019-0016.

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