Modern Pediatrics. Ukraine. (2023). 3(131): 13-21. doi 10.15574/SP.2023.131.13
Voloshin O. M.¹, Marushko Yu. V.², Savchenko I. I.^1
1Luhansk State Medical University, Rivne, Ukraine
²Bogomolets National Medical University, Kyiv, Ukraine

For citation: Voloshin OM, Marushko YuV, Savchenko II. (2023). А bootstrap analysis of immune status in preschool children suffering from recurrent respiratory infections. Modern Pediatrics. Ukraine. 3(131): 13-21. doi 10.15574/SP.2023.131.13.
Article received: Jan 13, 2023. Accepted for publication: Apr 11, 2023.

Purpose – to carry out a systematic analysis of humoral and blood cellular immunity parameters in preschool children with a different frequency of acute respiratory infection (ARI) during the previous year using bootstrap analysis.
Materials and methods. Twenty-six children (11 boys and 15 girls) aged 1 to 4 years old, undergoing inpatient treatment on ARI, were involved in the clinical study. Serum concentrations of immunoglobulins (Ig) of classes A, M, G, E and a number of blood cellular immunity parameters were studied. Also, two indicators of ARI recurrence were calculated, namely, the infectious index and the resistance index. The statistical processing of the primary digital material obtained was performed by IBM SPSS Statistics 28 licensed program.
Results. A direct moderate bootstrap correlation between the resistance index and serum IgA concentration in the preschool children with the different frequency of ARI according to their anamnesis (Bρ=0.407; p<0.001 [0.397-0.418]) was established. A rank correlation analysis, a multiple linear and an ordinal logistic regression combined with bootstrapping showed no significant relationship between particular serum Ig, on the one hand, and particular blood cellular immunity parameters, on the other hand. A partial bootstrap correlation analysis revealed the significant influence of many covariates studied on the strength of relationship between the indicators in the selected pair combinations.
Conclusions. Provided the initial quantitative limitation of the observation group of the preschool children suffering from recurrent respiratory infections, the bootstrapping procedure applied significantly expands the interpretive possibilities of the clinical and immunological study results. Besides the standard estimation of the asymptotic significance of partial correlation coefficients, the bootstrap definition of their 95% confidence interval is an additional and highly informative way to check the results’ statistical validity.
The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committees of the institutions mentioned in the paper. An informed parental consent was obtained for the study in children.
No conflict of interests was declared by the authors.
Keywords: preschool children, recurrent respiratory infections, serum immunoglobulins, blood cellular immunity parameters, bootstrapping.

REFERENCES

1. Ballarini S, Rossi GA, Principi N, Esposito S. (2021). Dysbiosis in Pediatrics Is Associated with Respiratory Infections: Is There a Place for Bacterial-Derived Products? Microorganisms. 9 (2): 448. https://doi.org/10.3390/microorganisms9020448; PMid:33671586 PMCid:PMC7926342

2. Cheng Z, Cai M, Tao H, He Z, Lin X, Lin H, Zuo Y. (2016). Efficiency and productivity measurement of rural township hospitals in China: a bootstrapping data envelopment analysis. BMJ Open. 6: e011911. https://doi.org/10.1136/bmjopen-2016-011911; PMid:27836870 PMCid:PMC5129104

3. Chernyshova LI. (2018). Recurrent respiratory diseases in children: the physician's action algorithm (lecture). Sovremennaya pediatriya. 3: 92-97. https://doi.org/10.15574/SP.2018.91.92

4. Di Felice G, Vidali M, Parisi G et al. (2022). Reference Intervals for Coagulation Parameters in Developmental Hemostasis from Infancy to Adolescence. Diagnostics. 12 (10): 2552. https://doi.org/10.3390/diagnostics12102552; PMid:36292241 PMCid:PMC9601585

5. Feleszko W, Marengo R, Vieira AS, Ratajczak K, Mayorga Butrón JL. (2019). Immunity-targeted approaches to the management of chronic and recurrent upper respiratory tract disorders in children. Clinscal Otolaryngology. 44: 502-510. https://doi.org/10.1111/coa.13335; PMid:30920131 PMCid:PMC6850198

6. Florin TA, Ambroggio L, Lorenz D, Kachelmeyer A, Ruddy RM, Kuppermann N, Shah SS. (2021). Development and Internal Validation of a Prediction Model to Risk Stratify Children With Suspected Community-Acquired Pneumonia. Clinical Infectious Diseases. 73 (9): e2713-e2721. https://doi.org/10.1093/cid/ciaa1690; PMid:33159514 PMCid:PMC8563216

7. Jaybhaye AP, Sangle AL, Ugra D, Chittal RY. (2022). A Hospital-Based Study of Vitamin D Levels in Children With Recurrent Respiratory Infections. Cureus. 14 (8): e27864. https://doi.org/10.7759/cureus.27864; PMid:36110478 PMCid:PMC9462840

8. Ji J, Yuan Z, Zhang X et al. (2015). Detection for pathway effect contributing to disease in systems epidemiology with a case-control design. BMJ Open. 5: e006721. https://doi.org/10.1136/bmjopen-2014-006721; PMid:25596199 PMCid:PMC4298111

9. Kim SY, Jang MS, Kim J. (2022). Impact of Third-Generation Cephalosporin Resistance on Recurrence in Children with Febrile Urinary Tract Infections. Journal of Personalized Medicine. 12 (5): 773. https://doi.org/10.3390/jpm12050773; PMid:35629195 PMCid:PMC9144345

10. Kramarov SA, Yevtushenko VV. (2019). Experience with application of nasal interferon in the treatment and prevention of acute respiratory infections. Actual Infectology. 7 (4): 217-223. https://doi.org/10.22141/2312-413x.7.4.2019.178883

11. Lambert L, Culley FJ. (2017). Innate Immunity to Respiratory Infection in Early Life. Frontiers in Immunology. 8: 1570. https://doi.org/10.3389/fimmu.2017.01570; PMid:29184555 PMCid:PMC5694434

12. Lemko OI, Lukashchuk SV. (2019). Recurrent respiratory diseases in practice of family physician and pediatrician: main issues (a literature review). Zaporozhye medical journal. 21 (6): 835-842. https://doi.org/10.14739/2310-1210.2019.6.186715

13. Li H, Cui QK, Li Z, Li J, Li F. (2021). Clinical observation of the effect of modified Ginseng-Schisandra decoction (MGSD) on trace elements and immune function in children with spleen deficiency syndrome after recurrent respiratory tract infection (RRTI): a randomized controlled trial. Translational Pediatrics. 10 (6): 1692-1700. https://doi.org/10.21037/tp-21-243; PMid:34295784 PMCid:PMC8261592

14. Li KL, Wang BZ, Li ZP, Li YL, Liang JJ. (2019). Alterations of intestinal flora and the effects of probiotics in children with recurrent respiratory tract infection. World Journal of Pediatrics. 15: 255-261. https://doi.org/10.1007/s12519-019-00248-0; PMid:31020541 PMCid:PMC6597592

15. Ogata K. (2021). On the Application of Bootstrapping and Monte Carlo Simulations to Clinical Studies: Psychometric Intelligence Research and Juvenile Delinquency. Psychology. 12: 1171-1183. https://doi.org/10.4236/psych.2021.128072

16. Peeters D, van Geloven N, Visser LE et al. (2021). Study protocol for a randomised controlled trial evaluating the clinical effect of antibiotic prophylaxis in children with recurrent respiratory tract infections: the Approach study. BMJ Open. 11 (7): e044505. https://doi.org/10.1136/bmjopen-2020-044505; PMid:34326043 PMCid:PMC8323378

17. Raniszewska A, Górska E, Kotuła I, Stelmaszczyk-Emmel A, Popko K, Ciepiela O. (2015). Recurrent respiratory tract infections in children – analysis of immunological examinations. Central European Journal of Immunology. 40 (2): 167-173. https://doi.org/10.5114/ceji.2015.52830; PMid:26557030 PMCid:PMC4637391

18. Schaad UB, Esposito S, Razi CH. (2016). Diagnosis and Management of Recurrent Respiratory Tract Infections in Children: A Practical Guide. Archives of Pediatric Infectious Diseases. 4 (1): e31039. https://doi.org/10.5812/pedinfect.31039

19. Shumna ТYe, Nedelska SM, Solovieva SV, Masur VI, Kolesnik OYa. (2017). Characteristic of cellular immunity in children with recurrent respiratory diseases, depending on the level of immunoglobulin E production. Zaporozhye medical journal. 19 (6): 769-772. https://doi.org/10.14739/2310-1210

20. Soeteman M, Kappen TH, van Engelen M et al. (2023). Validation of a modified bedside Pediatric Early Warning System score for detection of clinical deterioration in hospitalized pediatric oncology patients: A prospective cohort study. Pediatric Blood & Cancer. 70: e30036. https://doi.org/10.1002/pbc.30036; PMid:36316817

21. Srivastava R, Dunbar M, Shevell M et al. (2022). Development and Validation of a Prediction Model for Perinatal Arterial Ischemic Stroke in Term Neonates. JAMA Network Open. 5 (6): e2219203. https://doi.org/10.1001/jamanetworkopen.2022.19203; PMid:35767262 PMCid:PMC9244611

22. Voloshin OM, Marushko YuV, Dontsova KM. (2020). Recurrent respiratory diseases and humoral immune status in preschool children. Eastern Ukrainian Medical Journal. 8 (4): 393-401. https://doi.org/10.21272/eumj.2020;8(4):393-401

23. Voloshin OM, Marushko YuV. (2021). Peculiarities of cellular immunity among preschool children suffering from recurrent respiratory diseases. Bulletin of problems biology and medicine. 1: 337-342. https://doi.org/10.29254/2077-4214-2021-1-159-337-342

24. Voloshin OM, Marushko YuV. (2022). Comprehensive analysis of serum concentration of matrix metalloproteinase 1 and tissue inhibitor of metalloproteinase 1 in preschool children suffering from recurrent respiratory infections. Modern Pediatrics. Ukraine. 7: 29-37. https://doi.org/10.15574/SP.2022.127.29

25. Zeqo LM, Tasho EM, Karanxha J. (2022). Bootstrapping the coefficients of multiple logistic regression model in medicine data. Asian-European Journal of Mathematics. 15 (10): 2250248. https://doi.org/10.1142/S1793557122502485