To the Editor: The recent study by Samynathan et al., published in the Indian Journal of Pediatrics, explored the prognostic relevance of the neutrophil-to-lymphocyte ratio (NLR) in critically ill children and reported an association between elevated NLR and unfavorable outcomes [
1]. This prospective work contributes meaningfully to the search for accessible immune-related biomarkers in pediatric intensive care. We respectfully offer several considerations that may inform future investigations. …