1
|
Yuan Y, Huang J, Yu J, Tan JKS, Chng KZ, Lee J, Kim S. Application of machine learning algorithms for accurate determination of bilirubin level on in vitro engineered tissue phantom images. Sci Rep 2024; 14:5952. [PMID: 38467676 PMCID: PMC10928098 DOI: 10.1038/s41598-024-56319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/05/2024] [Indexed: 03/13/2024] Open
Abstract
Neonatal Jaundice is a common occurrence in neonates. High excess bilirubin would lead to hyperbilirubinemia, leading to irreversible adverse damage such as kernicterus. Therefore, it is necessary and important to monitor neonates' bilirubin levels in real-time for immediate intervention. However, current screening protocols have their inherent limitations, necessitating more convenient measurements. In this proof-of-concept study, we evaluated the feasibility of using machine learning for the screening of hyperbilirubinemia in neonates from smartphone-acquired photographs. Different machine learning models were compared and evaluated to gain a better understanding of feature selection and model performance in bilirubin determination. An in vitro study was conducted with a bilirubin-containing tissue phantom to identify potential biological and environmental confounding factors. The findings of this study present a systematic characterization of the confounding effect of various factors through separate parametric tests. These tests uncover potential techniques in image pre-processing, highlighting important biological features (light scattering property and skin thickness) and external features (ISO, lighting conditions and white balance), which together contribute to robust model approaches for accurately determining bilirubin concentrations. By obtaining an accuracy of 0.848 in classification and 0.812 in regression, these findings indicate strong potential in aiding in the design of clinical studies using patient-derived images.
Collapse
Affiliation(s)
- Yijia Yuan
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore
- N.1 Institute for Health, National University of Singapore, Singapore, 119276, Singapore
| | - Jiayao Huang
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore
| | - Jiachen Yu
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore
- College of Biomedical Engineering and Instrument, Zhejiang University, Hangzhou, 310027, China
| | - Justin Kok Soon Tan
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore
- N.1 Institute for Health, National University of Singapore, Singapore, 119276, Singapore
| | | | - Jiun Lee
- Department of Neonatology, National University Health System, Singapore, 119228, Singapore
- Department of Paediatrics, National University of Singapore, Singapore, 119228, Singapore
| | - Sangho Kim
- Advanced Innovation in Micro/Nanoengineering (AIM) Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore, 119276, Singapore.
- N.1 Institute for Health, National University of Singapore, Singapore, 119276, Singapore.
| |
Collapse
|
2
|
Li CL, Tan C, Gao L, Chang Y, Fan WM. Establishment and validation of haematological reference intervals for newborns aged 5 to 28 days in Nanjing, China. Hematology 2023; 28:2208891. [PMID: 37183962 DOI: 10.1080/16078454.2023.2208891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND China lacks a standard for reference intervals (RIs) of complete blood cell (CBC) counts in newborns. This study aimed to determine local haematological RIs for newborns. METHODS This prospective study was conducted from January 2020 to December 2020 in Nanjing Maternity and Child Health Care Hospital. We collected capillary blood specimens from 497 healthy newborns aged 5-28 days. We calculated the RIs as nonparametric 2.5th to 97.5th percentiles and 90% confidence intervals following the EP28-A3c guideline. We validated the RIs in another 20 specimens from healthy newborns. RESULTS The RIs for the 18 CBC parameters were: white blood cell count 7.17-15.69 × 109/L; monocytes# 0.52-1.66 × 109/L; Mono% 5.7-14.1; eosinophils# 0.16-1.08 × 109/L; Eos% 1.5-8.9; Lymphocytes# 4.04-8.08 × 109/L; Lymph% 40.1-67.8; Neutrophils# 1.59-6.41 × 109/L; Neut% 18.1-46.7; Basophils# 0.00-0.04 × 109/L; Baso% 0.0-0.4; red blood cell count 3.38-5.89 × 1012/L; haemoglobin (Hb) 116-198 g/L; Hematocrit % 35.2-61.2; mean corpuscular Hb (MCH) 30.9-36.3 pg/L; MCH concentration 310-341 g/L; mean corpuscular volume 94.5-112.2 fL; and platelets 210-610 × 109/L. The RIs had a conformity rate of 90%-100% in the validation specimens. CONCLUSION We established region-specific RIs for CBC parameters in healthy newborns to help diagnose haematological disease in neonates.
Collapse
Affiliation(s)
- Chen-Li Li
- Department of Clinical Laboratory, Children's Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Cheng Tan
- Department of Clinical Laboratory, Children's Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Ling Gao
- Department of Clinical Laboratory, Children's Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yong Chang
- Department of Clinical Laboratory, Children's Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Wei-Min Fan
- Department of Clinical Laboratory, Nanjing Maternity and Child Health Care Hospital, Nanjing, People's Republic of China
| |
Collapse
|
3
|
Kitaoka H, Shitara Y, Kashima K, Ochiai S, Chikai H, Watanabe K, Ida H, Kumagai T, Takahashi N. Risk factors for anemia of prematurity among 30-35-week preterm infants. Fukushima J Med Sci 2023; 69:115-123. [PMID: 37164765 PMCID: PMC10480510 DOI: 10.5387/fms.2022-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/22/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The risk factors for anemia of prematurity (AOP) among late preterm infants are unelucidated. We identified risk factors for declining hemoglobin (Hb) concentration and triggering factors for AOP treatment in infants born at 30-35 gestational weeks. METHODS From 2012 to 2020, we conducted a single-center retrospective study of infants born at 30-35 weeks of gestation without congenital anomalies or severe hemorrhage. The primary outcome was AOP development, defined by initiation of treatments including red blood cell transfusion, subcutaneous injections of erythropoietin, and iron supplementation. A multivariable logistic regression model was used to investigate potential risk factors for AOP. RESULTS A total of 358 infants were included. Lower gestational age (odds ratio, 0.19; 95% confidence interval 0.11-0.32), small for gestational age (SGA; 7.17, 2.15-23.9), low maternal Hb level before birth (0.66, 0.49-0.87), low Hb at birth (0.71, 0.57-0.89), and multiple large blood samplings (1.79; 1.40-2.29) showed significantly higher odds for AOP development. CONCLUSIONS Gestational age, SGA, low maternal Hb before birth, Hb at birth, and high number of large blood samplings were positively associated with AOP development in infants born at 30-35 gestational weeks.
Collapse
Affiliation(s)
- Hiroki Kitaoka
- Department of Pediatrics, Yaizu City Hospital
- Department of Pediatrics, The University of Tokyo Hospital
| | | | - Kohei Kashima
- Department of Pediatrics, The University of Tokyo Hospital
| | | | - Hayato Chikai
- Department of Pediatrics, Yaizu City Hospital
- Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital
| | | | - Hiroto Ida
- Department of Pediatrics, Yaizu City Hospital
| | | | | |
Collapse
|
4
|
Sabnis K, Ghanghurde S, Shukla A, Sukheja D, Rojekar MV. An Indian perspective for umbilical cord blood haematological parameters reference interval. BMC Pediatr 2023; 23:287. [PMID: 37291518 PMCID: PMC10249286 DOI: 10.1186/s12887-023-04090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND The Haematological Reference Intervals (RIs) are prone to vary on the basis of various factors such as altitude, age, sex, socioeconomic status, etc. These values play a major role in laboratory data interpretation and determine the necessary clinical treatment. Currently, India has no well-established RI for cord blood haematological parameters of newborns. This study aims to establish these intervals from Mumbai, India. METHOD A cross sectional study was conducted in a tertiary care hospital of India from October 2022 to December 2022 on healthy and term neonates having normal birth weight and born to healthy pregnant mothers. About 2 - 3 mL of cord blood was collected from the clamped cord into EDTA tubes from 127 term neonates. The samples were analysed in the haematology laboratory of the institute and the data was analysed. The upper and lower limits were determined using non-parametric method. The Mann-Whitney U test was used to compare the distribution of the parameters between sex of infant, modes of deliveries, maternal age and obstetric history. P value less than 0.05 was considered to declare statistical significance. RESULT The median values and 95% RI for umbilical cord blood haematological parameters of newborns were as follows: WBC = 12.35 [2.56-21.19] × 109/L, RBC = 4.34 [2.45-6.27] × 1012/L, HGB = 14.7 [8.08-21.44] g/dL, HCT = 48 [29-67]%, MCV = 109.6 [59.04-159.1] fL, MCH = 34.5 [30.54-37.79] pg, MCHC = 31.3 [29.87-32.75] %, PLT = 249 [16.97-479.46] × 109/L,LYM = 38 [17-62] %, NEU = 50 [26-74] %, EOS = 2.3 [0.1-4.8] %, MON = 7.3 [3.1-11.4], BAS = 0 [0-1]. This study found no statistically significant difference between sex of infants, except MCHC, and obstetric history. A significant difference was observed in WBC, EOS% and absolute NEU, LYM, MON and BAS by delivery type. A higher platelet count and absolute LYM was observed in the cord blood compared to venous blood. CONCLUSIONS For the first time, haematological reference intervals in cord blood were established for newborns in Mumbai, India. The values are applicable for newborns from this area. Larger study throughout the country is required.
Collapse
Affiliation(s)
- Keyur Sabnis
- Rajiv Gandhi Medical College, 400605, Thane, India
| | - Swati Ghanghurde
- Department of Pathology, Rajiv Gandhi Medical College, 400605, Thane, India
| | - Akash Shukla
- Rajiv Gandhi Medical College, 400605, Thane, India
| | | | - Mohit V Rojekar
- Department of Biochemistry, Rajiv Gandhi Medical College, 400605, Thane, India.
| |
Collapse
|
5
|
Neonatal hematological parameters: the translational aspect of developmental hematopoiesis. Ann Hematol 2023; 102:707-714. [PMID: 36847806 DOI: 10.1007/s00277-023-05144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/20/2022] [Indexed: 03/01/2023]
Abstract
Hematopoiesis is a process constantly evolving from fetal life through adulthood. Neonates present with qualitative and quantitative differences in hematological parameters compared to older children and adults, reflecting developmental changes in hematopoiesis correlated with gestational age. Such differences are more intense for preterm and small-for-gestational-age neonates or neonates with intrauterine growth restriction. This review article is aimed at describing the hematologic differences among neonatal subgroups and the major underlying pathogenic mechanisms. Issues that should be taken into account when interpreting neonatal hematological parameters are also highlighted.
Collapse
|
6
|
Güler Kazancı E, Üstündağ Y, Akdoğan M, Yıldırım F, Arıkan EY, Huysal K. Red Cell Distribution Width to Platelet Count Ratio Reference Intervals in Premature Infants Beyond the First Week of Life. Fetal Pediatr Pathol 2023:1-8. [PMID: 36790354 DOI: 10.1080/15513815.2023.2178268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Objective: Red cell distribution width (RDW) is a parameter of complete blood count (CBC). The RDW to platelet count ratio (RPR) is a new index that has been shown to reflect the severity of inflammation. We aim to determine the reference interval (RI) of RPR for premature newborns. Study design: The medical records of preterm infants who were followed up between January 2016 and December 2018 were reviewed. CBC levels were measured in 144 infants at <72 hours of age. Results: CBCs of infants (gestational age from 28 to 35weeks) had a RI of 0.038-0.126 for the RPR. The RI for RPR in infants with a gestational age of 32-35weeks was 0.042-0.129; and the RI for infants at 28-31weeks was 0.022-0.121. Conclusion: Establishment of RI for RPR in premature infants will allow clinical correlation of RPR alterations in this population.
Collapse
Affiliation(s)
- Elif Güler Kazancı
- Department of Pediatric Hemato-Oncology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Yasemin Üstündağ
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Müberra Akdoğan
- Department of Ophtalmology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Fatih Yıldırım
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Elif Yalçın Arıkan
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Kağan Huysal
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| |
Collapse
|
7
|
Larsson SM, Hellström-Westas L, Hillarp A, Åkeson PK, Domellöf M, Askelöf U, Götherström C, Andersson O. Haemoglobin and red blood cell reference intervals during infancy. Arch Dis Child 2022; 107:351-358. [PMID: 34674992 PMCID: PMC8938674 DOI: 10.1136/archdischild-2021-321672] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/27/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES There is a need for updated haematological reference data in infancy. This study aimed to define intervals for haemoglobin and red blood cell biomarkers based on data from a large cohort of longitudinally followed Swedish infants. DESIGN Longitudinal cohort study. SETTING Two Swedish study centres. PARTICIPANTS Three community-based populations including 442 presumably healthy infants born at term and with umbilical cord clamping delayed to 30 s or more after birth. METHODS Blood samples were collected from umbilical cord blood (a), at 48-118 hours (b), at 4 months (c) and at 12 months (d). Reference intervals as the 2.5th and 97.5th percentiles were calculated in coherence with Clinical and Laboratory Standards Institute guidelines. RESULTS Reference intervals for haemoglobin (g/L) were: (a) 116-189, (b) 147-218, (c) 99-130, (d) 104-134, and for mean cell volume (fL): (a) 97-118, (b) 91-107, (c) 71-85, (d) 70-83. Reference intervals for erythrocyte counts, reticulocyte counts, reticulocyte haemoglobin, mean cell haemoglobin and mean cell haemoglobin concentration were also estimated. According to the WHO definition of anaemia, a haemoglobin value less than 110 g/L, 16% of this presumably healthy cohort could be classified as anaemic at 12 months. CONCLUSION We found mainly narrower reference intervals compared with previously published studies. The reference intervals for each parameter varied according to the infants' age, demonstrating the necessity of age definitions when presenting infant reference intervals. The discrepancy with the WHO classification for anaemia at 12 months, despite favourable conditions in infancy, needs future investigation.
Collapse
Affiliation(s)
- Sara Marie Larsson
- Department of Clinical Chemistry, Halland Hospital, Halmstad/Varberg, Sweden .,Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
| | | | - Andreas Hillarp
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Pia Karlsland Åkeson
- Department of Clinical Sciences Malmö, Preventive Paediatrics, Lund University, Lund, Sweden
| | - Magnus Domellöf
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - Ulrica Askelöf
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden
| | - Cecilia Götherström
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden
| | - Ola Andersson
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
| |
Collapse
|
8
|
Manna S, Biswas P, Haldar R, Naskar TK, Law S. Cord and peripheral blood erythrocyte analysis by scanning electron microscopy and flow cytometry. Int J Lab Hematol 2022; 44:679-687. [PMID: 35150189 DOI: 10.1111/ijlh.13810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/27/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Human umbilical cord blood is rich in hematopoietic cells. We aimed to focus on the morphological, biochemical, membrane protein profile and surface protein expression differences of erythrocytes, isolated from cord and adult peripheral blood using techniques such as high-resolution scanning electron microscopy (SEM), gel electrophoresis (SDS-PAGE) and flow cytometry. METHODS Adult peripheral blood was collected from consenting adults, and umbilical cord blood was procured from consenting mothers, post-delivery at Medical College, Kolkata. We emphasized on cord and adult peripheral blood erythrocytes' morphological variations using SEM images and protein expression by flow cytometric analysis. Some conventional biochemical analyses such as osmotic fragility of the cell membrane, haemoglobin co-oxidation study and lipid peroxidation assay were done for supporting evidence along with membrane protein content using gel electrophoresis. RESULTS Our SEM images indicated clear morphological variations in cord erythrocyte with a higher degree of cellular deformities and difference in membrane texture. Flow cytometric analysis of cord erythrocyte showed a significant difference in CD235a expression than adults. We observed an overexpression of GLUT1 and decreased expression of Band 3 in cord erythrocyte membrane. Our results also showed cord erythrocytes have low osmotic fragility, a slower rate of co-oxidation of cord haemoglobin and a lesser lipid peroxidation level than that of adults. CONCLUSION Cord blood erythrocytes have deeper indentations leading to higher flexibility, more oxygen-carrying capacity and less osmotic fragility in comparison with adult erythrocytes. The expression of CD235a and Band 4.5 (GLUT 1) was significantly higher in cord erythrocytes than peripheral adult erythrocytes.
Collapse
Affiliation(s)
- Sayak Manna
- Stem Cell Research and Application Unit, Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, Kolkata, India
| | - Payel Biswas
- Biophysics and Electrophysiology Unit, Department of Physiology, University of Calcutta, Kolkata, India
| | - Rajen Haldar
- Biophysics and Electrophysiology Unit, Department of Physiology, University of Calcutta, Kolkata, India
| | - Tapan Kumar Naskar
- Department of Obstetrics and Gynaecology, Medical College Kolkata, Kolkata, India
| | - Sujata Law
- Stem Cell Research and Application Unit, Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, Kolkata, India
| |
Collapse
|
9
|
Angelo A, Derbie G, Demtse A, Tsegaye A. Umbilical cord blood hematological parameters reference interval for newborns from Addis Ababa, Ethiopia. BMC Pediatr 2021; 21:275. [PMID: 34116664 PMCID: PMC8194248 DOI: 10.1186/s12887-021-02722-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/17/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Several factors like altitude, age, sex, pregnancy, socioeconomic status, life style and race influence hematological reference interval (RIs), which are critical to support clinical decisions and to interpret laboratory data in research. Currently there are no well-established RIs for cord blood hematological parameters of newborns in Ethiopia. This study aims to generate RIs for umbilical cord blood hematological parameters of newborns from Addis Ababa, Ethiopia. METHOD A cross-sectional study was conducted from January 1 to March 31, 2019 on healthy, term newborns (37-42 weeks) with normal birth weight born to apparently healthy pregnant mothers who had met the eligibility criteria. From 139 newborns, 2-3ml cord blood was immediately collected from the clumped cord using EDTA tube. The samples were analyzed using Sysmex KX 21 hematology analyzer. Data was entered and the 2.5th and 97.5th percentiles (upper and lower reference limit) were determined using non parametric method by SPSS version 23. The non-parametric independent Mann-Whitney U test (Wilcoxon rank-sum test) was used to compare the distribution of the parameters between genders, modes of deliveries and gestational age. P value less than 0.05 was considered to declare statistical significance. RESULT The median values and 95 % reference interval for umbilical cord blood hematological parameters of newborns were as follows: WBC = 12.4 [6.6-19.4] x109/L, RBC = 4.51 [3.55-5.52] x1012/L, HGB = 15.8 [12.4-19.7] g/dL, HCT = 45.9[37.9-56.3]%, MCV = 102.1[83.9-111.6] fL, MCH = 35.3 [29.4-39.1] pg, MCHC = 34.3 [32.3-37.4] %, PLT = 236 [146-438] x109/L, LYM = 37.5 [16.6-63.0] %, MXD = 7.9[1.7-15.8] %, NEU = 53.7[30.3-78.4] %, RDW = 15.6[12.0-19.0]%, PDW = 11.0[9.1-15.7]% and MPV = 9.4[8.1-11.8] fL. The current study found no significant difference between genders, except RDW (P = 0.01), and gestational age group, but there was significant difference for WBC (p = 0.007), RBC (p = 0.018) and Absolute NEU (p = 0.001) by delivery type where newborns delivered through caesarean section had lower values for these three parameters compared to those with spontaneous delivery. CONCLUSIONS hematological reference intervals in cord blood were established for the first time from healthy newborns of Addis Ababa and its surrounding. The values are applicable for newborns from this area. Larger study throughout the country is warranted.
Collapse
Affiliation(s)
- Ammanuel Angelo
- Department of Medical Laboratory, St Peter Specialized Hospital, Addis Ababa, Ethiopia
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girma Derbie
- Department of Obstetrics and Gynecology, St Peter Specialized Hospital, Addis Ababa, Ethiopia
| | - Asrat Demtse
- Department of Pediatrics and Child Health, School of Medicine/Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
10
|
Yaqub L, Ayo J, Habibu B, Kawu M, Rekwot P. Haematological responses and erythrocyte osmotic fragility in pregnant Yankasa ewes and their lambs. Small Rumin Res 2021. [DOI: 10.1016/j.smallrumres.2021.106352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
Chapron BD, Chapron A, Leeder JS. Recent advances in the ontogeny of drug disposition. Br J Clin Pharmacol 2021; 88:4267-4284. [PMID: 33733546 DOI: 10.1111/bcp.14821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022] Open
Abstract
Developmental changes that occur throughout childhood have long been known to impact drug disposition. However, pharmacokinetic studies in the paediatric population have historically been limited due to ethical concerns arising from incorporating children into clinical trials. As such, much of the early work in the field of developmental pharmacology was reliant on difficult-to-interpret in vitro and in vivo animal studies. Over the last 2 decades, our understanding of the mechanistic processes underlying age-related changes in drug disposition has advanced considerably. Progress has largely been driven by technological advances in mass spectrometry-based methods for quantifying proteins implicated in drug disposition, and in silico tools that leverage these data to predict age-related changes in pharmacokinetics. This review summarizes our current understanding of the impact of childhood development on drug disposition, particularly focusing on research of the past 20 years, but also highlighting select examples of earlier foundational research. Equally important to the studies reviewed herein are the areas that we cannot currently describe due to the lack of research evidence; these gaps provide a map of drug disposition pathways for which developmental trends still need to be characterized.
Collapse
Affiliation(s)
- Brian D Chapron
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Alenka Chapron
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - J Steven Leeder
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA.,Schools of Medicine and Pharmacy, University of Missouri-Kansas City, MO, USA
| |
Collapse
|
12
|
Ianni B, McDaniel H, Savilo E, Wade C, Micetic B, Johnson S, Gerkin R. Defining Normal Healthy Term Newborn Automated Hematologic Reference Intervals at 24 Hours of Life. Arch Pathol Lab Med 2021; 145:66-74. [PMID: 33367662 DOI: 10.5858/arpa.2019-0444-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Automated analyzers have advanced the field of clinical hematology, mandating updated complete blood count (CBC) reference intervals (RIs) to be clinically useful. Contemporary newborn CBC RI publications are mostly retrospective, which some authors have cited as one of their cardinal limitations and recommended future prospective studies. OBJECTIVE.— To prospectively establish accurate hematologic RIs for normal healthy term newborns at 24 hours of life given the limitations of the current medical literature. DESIGN.— This prospective study was conducted at an academic tertiary care center, and hematology samples were collected from 120 participants deemed to be normal healthy term newborns. Distributions were assessed for normality and tested for outliers. Reference intervals were values between the 2.5th percentile and 97.5th percentile. RESULTS.— The novel RIs obtained for this study population are as follows: absolute immature granulocyte count, 80/μL to 1700/μL; immature granulocyte percentage, 0.6% to 6.1%; reticulocyte hemoglobin equivalent, 31.7 to 38.4 pg; immature reticulocyte fraction, 35.9% to 52.8%; immature platelet count, 4.73 × 103/μL to 19.72 × 103/μL; and immature platelet fraction, 1.7% to 9.8%. CONCLUSIONS.— This prospective study has defined hematologic RIs for this newborn population, including new advanced clinical parameters from the Sysmex XN-1000 Automated Hematology Analyzer. These RIs are proposed as the new standard and can serve as a strong foundation for continued research to further explore their value in diagnosing and managing morbidities such as sepsis, anemia, and thrombocytopenia.
Collapse
Affiliation(s)
- Barbara Ianni
- From the Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona.,University of Arizona College of Medicine - Phoenix.,Neonatal Intensive Care Unit, Banner - University Medical Center Phoenix, Phoenix, Arizona (Ianni)
| | - Holly McDaniel
- Laboratory, Banner Desert and Cardons Children's Medical Centers, Laboratory Sciences of Arizona, Mesa (McDaniel)
| | - Elena Savilo
- Laboratory, Banner - University Medical Center Phoenix, Laboratory Sciences of Arizona, Phoenix (Savilo)
| | - Christine Wade
- Clinical Research, Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona (Wade, Micetic, Johnson)
| | - Becky Micetic
- Clinical Research, Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona (Wade, Micetic, Johnson)
| | - Scott Johnson
- Clinical Research, Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona (Wade, Micetic, Johnson)
| | - Richard Gerkin
- Department of Internal Medicine, Banner - University Medical Center Phoenix, Phoenix, Arizona and University of Arizona College of Medicine - Phoenix (Gerkin)
| |
Collapse
|
13
|
Cui D, Hou Y, Feng L, Li G, Zhang C, Huang Y, Fan J, Hu Q. Capillary blood reference intervals for platelet parameters in healthy full-term neonates in China. BMC Pediatr 2020; 20:471. [PMID: 33038919 PMCID: PMC7547422 DOI: 10.1186/s12887-020-02373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/06/2020] [Indexed: 12/02/2022] Open
Abstract
Background No consensus has been reached on capillary blood reference intervals for platelet parameters in full-term neonates. We aimed to establish neonatal capillary blood reference intervals for platelet parameters and evaluate influences of sex, gestational age and postnatal age on platelet parameters. Methods This study was a prospective investigation and implemented in 594 healthy full-term neonates from 12 to 84 h of age, using SYSMEX XN-9000 haematology automatic analyser by means of capillary blood. Reference intervals for platelet parameters were defined by an interval of 2.5th − 97.5th percentiles. Results Capillary reference interval for platelet count was (152–464) × 109/L. No significance was found between sex-divided reference intervals for platelet parameters. The values of platelet count changed minimally across gestational age (37–41 weeks) and postnatal age (12–84 h). Reference intervals for other platelet parameters were affected by these factors to a different extent. Conclusions We established capillary blood reference intervals for platelet parameters in the first days after birth of full-term neonates in China.
Collapse
Affiliation(s)
- Dongyan Cui
- Department of Paediatric Haematology and Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Yan Hou
- Department of Paediatrics, Xiangyang Central Hospital, Xiangyang, 441021, Hubei Province, People's Republic of China
| | - Ling Feng
- Department of Gynaecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Guo Li
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Chi Zhang
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Yanli Huang
- Department of Gynaecology and Obstetrics, Xiangyang Central Hospital, Xiangyang, 441021, Hubei Province, People's Republic of China
| | - Jiubo Fan
- Department of Clinical Laboratory, Xiangyang Central Hospital, Xiangyang, 441021, Hubei Province, People's Republic of China
| | - Qun Hu
- Department of Paediatric Haematology and Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, People's Republic of China.
| |
Collapse
|
14
|
Scheffer-Mendoza S, Espinosa-Padilla SE, López-Herrera G, Mujica-Guzmán F, López-Padilla MG, Berrón-Ruiz L. Reference values of leukocyte and lymphocytes populations in umbilical cord and capillary blood in healthy Mexican newborns. Allergol Immunopathol (Madr) 2020; 48:295-305. [PMID: 32312563 DOI: 10.1016/j.aller.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/19/2019] [Accepted: 12/17/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In newborns, dramatic changes occur in the blood and bone marrow during the first hours; there are rapid fluctuations in the quantities of leukocytes populations. In this work, we investigated leukocytes subsets counts in two types of blood samples (cord blood and capillary blood) extracted from healthy newborns. METHODS Blood samples from Mexican neonates were collected by Instituto Nacional de Pediatría with written informed consent. For all samples we determined leukocytes populations; neutrophils, monocytes, total lymphocytes, and populations: T CD3+ cells, TCD4+ cells, T CD8+ cells, B CD19+ cells and NK CD16+56 cells by flow cytometry. We used the Mann-Whitney U test to compare leukocytes of cord and capillary blood; also to analyze the differences between gender and we obtained reference values of the cord and capillary blood in neonates. RESULTS We observed higher absolute counts and frequencies of total lymphocyte in capillary blood compared with cord blood. In absolute numbers, the capillary blood showed significant differences in neutrophils, monocytes, lymphocytes, T CD3+ cells, T CD4+ cells, T CD8+ cells, B CD19+ cells, and NK cells; no significant differences were observed between genders. DISCUSSION Our data contribute to newborn Mexican reference values for all these populations of leukocytes. We found that the dispersal range differs between the two types of blood, suggesting a different fate in the immune response. Immunophenotyping of the blood cell population to identify these cells is an essential tool in the diagnosis and follow-up of neonates with immunodeficiencies and other immune disorders.
Collapse
Affiliation(s)
- S Scheffer-Mendoza
- Servicio de Inmunología y Alergia, Instituto Nacional de Pediatría, SSa, Ciudad de México, Mexico
| | - S E Espinosa-Padilla
- Unidad de Investigación en Inmunodeficiencias, Instituto Nacional de Pediatría, SSa, Ciudad de México, Mexico
| | - G López-Herrera
- Laboratorio de Hematología, Instituto Nacional de Pediatría, SSa, Ciudad de México, Mexico
| | - F Mujica-Guzmán
- Laboratorio de Hematología, Instituto Nacional de Pediatría, SSa, Ciudad de México, Mexico
| | - M G López-Padilla
- Unidad Tocoquirúgica, Instituto Nacional de Enfermedades Respiratorias "Dr. Manuel Gea González", SSa, Ciudad de México, Mexico
| | - L Berrón-Ruiz
- Unidad de Investigación en Inmunodeficiencias, Instituto Nacional de Pediatría, SSa, Ciudad de México, Mexico.
| |
Collapse
|
15
|
Qi B, Nicolaï J, Smits A, De Vocht T, Deferm N, Van Brantegem P, Allegaert K, Annaert P. A sensitive liquid chromatography method for analysis of propofol in small volumes of neonatal blood. J Clin Pharm Ther 2019; 45:128-133. [PMID: 31583723 DOI: 10.1111/jcpt.13038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/10/2019] [Accepted: 08/08/2019] [Indexed: 12/13/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Sampling volumes of blood from neonates is necessarily limited. However, most of the published propofol analysis assays require a relatively large blood sample volume (typically ≥0.5 mL). Therefore, the aim of the present study was to develop and validate a sensitive method requiring a smaller sample volume (0.2 mL) to fulfill clinically relevant research requirements. METHODS Following simple protein precipitation and centrifugation, the supernatant was injected into the HPLC-fluorescence system and separated with a reverse phase column. Propofol and the internal standard (thymol) were detected and quantified using fluorescence at excitation and emission wavelengths of 270 nm and 310 nm, respectively. The method was validated with reference to the Food and Drug Administration (FDA) guidance for industry. Accuracy (CV, %) and precision (RSD, %) were evaluated at three quality control concentration levels (0.05, 0.5 and 5 µg/mL). RESULTS AND DISCUSSION Calibration curves were linear in the range of 0.005-20 µg/mL. Intra- and interday accuracy (-4.4%-13.6%) and precision (0.2%-5.8%) for propofol were below 15%. The calculated LOD (limit of detection) and LLOQ (lower limit of quantification) were 0.0021 µg/mL and 0.0069 µg/mL, respectively. Propofol samples were stable for 4 months at -20°C after the sample preparation. This method was applied for analyzing blood samples from 41 neonates that received propofol, as part of a dose-finding study. The measured median (range) concentration was 0.14 (0.03-1.11) µg/mL, which was in the range of the calibration curve. The calculated median (range) propofol half-life of the gamma elimination phase was 10.4 (4.7-26.7) hours. WHAT IS NEW AND CONCLUSION A minimal volume (0.2 mL) of blood from neonates is required for the determination of propofol with this method. The method can be used to support the quantification of propofol drug concentrations for pharmacokinetic studies in the neonatal population.
Collapse
Affiliation(s)
- Bing Qi
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Johan Nicolaï
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Anne Smits
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Tom De Vocht
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Neel Deferm
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Pieter Van Brantegem
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pieter Annaert
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
16
|
Butler AL, Fallon JK, Alter G. A Sample-Sparing Multiplexed ADCP Assay. Front Immunol 2019; 10:1851. [PMID: 31456799 PMCID: PMC6700248 DOI: 10.3389/fimmu.2019.01851] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022] Open
Abstract
Antibodies serve as the primary correlate of protection following most clinically approved vaccines and are thought to confer protection in part through their ability to block (neutralize) infection. Increasingly, studies have shown that beyond their blocking activities, the ability of antibodies to leverage the innate immune response may serve a vital role in protection from infection. Specifically, antibodies can drive phagocytosis, complement activation, and cellular cytotoxicity by interacting with Fc-receptors found on all innate immune cells. Measuring the capacity of antibodies to induce these functions has become critical for the identification of correlates of protection in large-scale vaccine trials. Therefore, there is a growing need to develop robust, high throughput assays able to interrogate the functional capacity of innate immune recruiting antibodies. However, in many instances, only small sample volumes are available. Nevertheless, profiling antibody functions across many pathogen-associated antigens or across global intra-pathogen variants is in high demand, making sample sparing approaches to perform this antibody evaluation critical. Here we describe the development of an approach to interrogate the functional activity of antibodies in serum against up to 5 antigen targets simultaneously. A single bead-based cellular assay was adapted to accommodate 5 different fluorescently colored beads, allowing for the concurrent investigation of antibody responses directed against multiple antigens in a single well. The multiplexed assay was as sensitive, specific, and accurate as the single antigen assay and robustly able to assess functional differences mediated by antibodies across different samples. These findings show multiplexing allows for accurate and more efficient analysis of antibody-mediated effector profiles.
Collapse
Affiliation(s)
| | | | - Galit Alter
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, United States
| |
Collapse
|
17
|
Kim SY, Lee SM, Sung SJ, Han SJ, Kim BJ, Park CW, Park JS, Jun JK. Red cell distribution width as a potential prognostic biomarker in fetal growth restriction. J Matern Fetal Neonatal Med 2019; 34:883-888. [PMID: 31113275 DOI: 10.1080/14767058.2019.1622665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Red cell distribution width (RDW) is a prognostic marker for adverse outcomes in cardiovascular disease. This association has been attributed to the impaired erythropoiesis and abnormal red blood cell survival originating from chronic hypoxic status or poor nutrition. Considering the pathophysiologic association between fetal growth restriction (FGR) and chronic intrauterine hypoxia, which in turn can result in impaired erythropoiesis, RDW could be a biomarker in FGR. To address this issue, we evaluated the RDW in FGR. STUDY DESIGN The study population consisted of singleton preterm neonates (24-34 weeks of gestation) and RDW in cord blood was measured at delivery, and was compared between small-for-gestational age (SGA) neonates (birthweight <10 percentile) and non-SGA neonates (birthweight >10 percentile). Among them, RDW was also examined according to the adverse neonatal outcomes. RESULTS Five hundred eighty-four neonates were included, of these, 117 SGA neonates and 467 non-SGA neonates. RDW in the SGA neonates was significantly higher than that in the non-SGA neonates (18.4 versus 16.4, p < .001). This association between SGA and RDW remained significant after adjustment for gestational age at delivery, histologic chorioamnionitis, and hematologic parameters. Among the SGA neonates, RDW was higher in neonates with adverse neonatal outcomes than those without them. The RDW >90 percentile was an independent parameter for the prediction of neonatal outcomes, even after adjustment. CONCLUSION The RDW was higher in the SGA neonates and was associated with adverse outcomes. RDW can be a prognostic marker in predicting outcomes among preterm neonates.
Collapse
Affiliation(s)
- So Yeon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Su Jin Sung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Soo Jin Han
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Byoung Jae Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
18
|
Das A, Ray S, Chattopadhyay A, Hazra A, Mondal R. Gestation-wise Reference Ranges of Neutrophil Counts in Indian Newborns. Oman Med J 2019; 34:131-136. [PMID: 30918607 PMCID: PMC6425059 DOI: 10.5001/omj.2019.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives Blood counts are commonly performed tests in neonatal intensive care units with the results having various clinical ramifications. Interpreting blood counts as normal or abnormal requires reference ranges as per gestation. Studies on reference ranges for neonatal neutrophil counts are already scarce, and data is lacking in the Asian context. We sought to formulate gestation-wise reference ranges of neutrophil counts in an Indian setting. Methods Healthy, newborn babies of either gender, aged between 30 to 41 weeks gestation were included in the study. Gestational age was corroborated through first trimester dating scan and postnatally by the New Ballard Score. Single venous blood samples were drawn on day three and day five for estimation of total leukocyte count, differential count (neutrophils, lymphocytes), and peripheral blood smear examination. Results We evaluated the data of 420 newborns. The normative values were compiled week-wise for gestational ages of 30 to 41 weeks at birth. We observed a clustering of neutrophil count values below 8000 cells/μL on day three and below 5000 cells/μL on day five. No gender-based differences in counts were observed. We were able to generate reference range curves for neutrophil counts as per gestational age. Conclusions The absolute neutrophil counts of term and preterm Indian newborns are higher than the values depicted in the standard reference chart used currently. This indicates that a different standard chart as per gestation should be used in Indo-Asian countries to differentiate ‘normal’ from ‘abnormal’.
Collapse
Affiliation(s)
- Arijita Das
- Department of Pediatric Medicine, Medical College, Kolkata, India
| | - Somosri Ray
- Department of Neonatology, Medical College, Kolkata, India
| | - Arnab Chattopadhyay
- Department of Hematology and Transfusion Medicine, Medical College, Kolkata, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Rakesh Mondal
- Department of Pediatric Medicine, Medical College, Kolkata, India
| |
Collapse
|
19
|
Ali AENAEG, Mahmoud AM. Correlation between Mode of Delivery and Newborn’s Cord Blood Composition. OPEN JOURNAL OF OBSTETRICS AND GYNECOLOGY 2019; 09:395-403. [DOI: 10.4236/ojog.2019.93040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
20
|
Gutvirtz G, Wainstock T, Sheiner E, Landau D, Slutzky A, Walfisch A. Long-term pediatric hematological morbidity of the early-term newborn. Eur J Pediatr 2018; 177:1625-1631. [PMID: 30088135 DOI: 10.1007/s00431-018-3223-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/25/2018] [Indexed: 11/29/2022]
Abstract
Children born at early term (37 0/7 to 38 6/7 weeks' gestation) are at an increased risk for long-term respiratory, cardiovascular, neurological, and developmental morbidities as compared with children born at full term (39 0/7 to 40 6/7 weeks' gestation). In this population-based cohort analysis, we sought to evaluate the long-term hematological morbidity of early-term born children. The cohort consisted of 223,242 term singleton deliveries. Hospitalizations of the offspring up to 18 years of age involving hematological morbidity were evaluated, including hereditary and acquired anemias, immunodeficiency disorders, coagulation disorders, white blood cell disorders, cytopenias, polycythemia, and myelodysplastic syndrome. Hematological hospitalizations were significantly more common in children delivered at early term as compared with those born at later gestational ages. A Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of hematological-related hospitalizations in the early-term born group (logrank p < 0.001). Using a Cox regression model, early-term delivery was found to be an independent risk factor for childhood hematological morbidity with an adjusted hazard ratio of 1.15 (95%CI 1.01-1.30, p=0.027).Conclusion: Early-term delivery appears to be independently associated with pediatric long-term hematological morbidity of the offspring. What is Known? • It has been shown that children born at early term are at increased risk for short-term adverse outcomes including perinatal mortality. • Early-term infants are also at increased risk for long-term morbidity, mainly respiratory. What is New? • Early-term delivery is also independently associated with long-term hematological morbidity of the offspring.
Collapse
Affiliation(s)
- Gil Gutvirtz
- Department of Obstetrics and Gynecology, Soroka University Medical Center (SUMC), Ben-Gurion University of the Negev, 151 Izak Rager Ave., 84101, Beer-Sheva, Israel.
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center (SUMC), Ben-Gurion University of the Negev, 151 Izak Rager Ave., 84101, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center (SUMC), Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alon Slutzky
- Department of Obstetrics and Gynecology, Soroka University Medical Center (SUMC), Ben-Gurion University of the Negev, 151 Izak Rager Ave., 84101, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center (SUMC), Ben-Gurion University of the Negev, 151 Izak Rager Ave., 84101, Beer-Sheva, Israel
| |
Collapse
|
21
|
Kim YG, Kwon JA, Moon Y, Park SJ, Kim S, Lee HA, Ko SY, Chang EA, Nam MH, Lim CS, Yoon SY. An Automated Draft Report Generator for Peripheral Blood Smear Examinations Based on Complete Blood Count Parameters. Ann Lab Med 2018; 38:512-517. [PMID: 30027693 PMCID: PMC6056392 DOI: 10.3343/alm.2018.38.6.512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/01/2018] [Accepted: 06/26/2018] [Indexed: 11/19/2022] Open
Abstract
Background Complete blood count (CBC) results play an important role in peripheral blood smear (PBS) examinations. Many descriptions in PBS reports may simply be translated from CBC parameters. We developed a computer program that automatically generates a PBS draft report based on CBC parameters and age- and sex-matched reference ranges. Methods The Java programming language was used to develop a computer program that supports a graphical user interface. Four hematology analyzers from three different laboratories were tested: Sysmex XE-5000 (Sysmex, Kobe, Japan), Sysmex XN-9000 (Sysmex), DxH800 (Beckman Coulter, Brea, CA, USA), and ADVIA 2120i (Siemens Healthcare Diagnostics, Eschborn, Germany). Input data files containing 862 CBC results were generated from hematology analyzers, middlewares, or laboratory information systems. The draft reports were compared with the content of input data files. Results We developed a computer program that reads CBC results from a data file and automatically writes a draft PBS report. Age- and sex-matched reference ranges can be automatically applied. After examining PBS, users can modify the draft report based on microscopic findings. Recommendations such as suggestions for further evaluations are also provided based on morphological findings, and they can be modified by users. The program was compatible with all four hematology analyzers tested. Conclusions Our program is expected to reduce the time required to manually incorporate CBC results into PBS reports. Systematic inclusion of CBC results could help improve the reliability and sensitivity of PBS examinations.
Collapse
Affiliation(s)
- Young Gon Kim
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jung Ah Kwon
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yeonsook Moon
- Department of Laboratory Medicine, Inha University School of Medicine, Incheon, Korea
| | - Seong Jun Park
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sangwook Kim
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyun A Lee
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sun Young Ko
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun Ah Chang
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Myung Hyun Nam
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chae Seung Lim
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea
| | - Soo Young Yoon
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea.
| |
Collapse
|
22
|
Growth Responses of Preterm Pigs Fed Formulas with Different Protein Levels and Supplemented with Leucine or β-Hydroxyl β-Methylbutyrate. Nutrients 2018; 10:nu10050636. [PMID: 29783624 PMCID: PMC5986515 DOI: 10.3390/nu10050636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/09/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022] Open
Abstract
Growth after preterm birth is an important determinant of long-term outcomes. Yet, many preterm infants suffer ex utero growth retardation. We evaluated effects of leucine and the metabolite, β-hydroxy β-methylbutyrate (HMB) on growth of preterm pigs, a previously-validated translational model for preterm infants. After 48 h of parenteral nutrition preterm pigs were fed for 6 to 7 days isocaloric formulas with different levels of protein (50 or 100 g/L) with leucine (10 g/L, 76 mM) or HMB (at 1.1 g/L, 4 mM) added to stimulate protein synthesis or with alanine (6.8 g/L; 76 mM) as the control. Rates of growth of pigs fed the low protein formula with alanine (3.4 ± 0.2% gain per day) or leucine (3.7 ± 0.2) exceeded that of pigs fed the high protein formula (2.8 ± 0.2, p = 0.02 for comparison with both low protein formulas; p = 0.01 compared with low protein + leucine). Supplementing the high protein formula with leucine or HMB did not increase growth relative to alanine (2.72 ± 0.20, 2.74 ± 0.27, and 2.52 ± 0.20, respectively). Small pigs (<700 g birth weight) grew slower during parenteral nutrition and had a more pronounced response to leucine. Females fed the high protein formulas grew faster than males, and particularly for small pigs (p < 0.05). Blood urea nitrogen values were lower for pigs fed the low versus the high protein formulas (p < 0.05). Leucine and HMB improved growth of preterm pigs fed low, but not high protein formulas, even after controlling for birth weight and sex, which independently correlated with growth rates. They offer an option to improve growth without increasing the amino acid load, with its attendant metabolic disadvantages.
Collapse
|
23
|
Brannon PM, Taylor CL. Iron Supplementation during Pregnancy and Infancy: Uncertainties and Implications for Research and Policy. Nutrients 2017; 9:E1327. [PMID: 29210994 PMCID: PMC5748777 DOI: 10.3390/nu9121327] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 12/29/2022] Open
Abstract
Iron is particularly important in pregnancy and infancy to meet the high demands for hematopoiesis, growth and development. Much attention has been given to conditions of iron deficiency (ID) and iron deficient anemia (IDA) because of the high global prevalence estimated in these vulnerable life stages. Emerging and preliminary evidence demonstrates, however, a U-shaped risk at both low and high iron status for birth and infant adverse health outcomes including growth, preterm birth, gestational diabetes, gastrointestinal health, and neurodegenerative diseases during aging. Such evidence raises questions about the effects of high iron intakes through supplementation or food fortification during pregnancy and infancy in iron-replete individuals. This review examines the emerging as well as the current understanding of iron needs and homeostasis during pregnancy and infancy, uncertainties in ascertaining iron status in these populations, and issues surrounding U-shaped risk curves in iron-replete pregnant women and infants. Implications for research and policy are discussed relative to screening and supplementation in these vulnerable populations, especially in developed countries in which the majority of these populations are likely iron-replete.
Collapse
Affiliation(s)
- Patsy M Brannon
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd, 3B01, Bethesda, MD 20892, USA.
| | - Christine L Taylor
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd, 3B01, Bethesda, MD 20892, USA.
| |
Collapse
|
24
|
|
25
|
Herzog EM, Eggink AJ, van der Zee M, Lagendijk J, Willemsen SP, de Jonge R, Steegers EAP, Steegers-Theunissen RPM. The impact of early- and late-onset preeclampsia on umbilical cord blood cell populations. J Reprod Immunol 2016; 116:81-5. [PMID: 27239988 DOI: 10.1016/j.jri.2016.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/27/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Abstract
Pregnancies complicated by preeclampsia (PE) are characterised by an enhanced maternal and fetal inflammatory response with increased numbers of leukocytes in maternal peripheral blood. The impact of PE on newborn umbilical cord blood cell (UCBC) populations however, has been scarcely studied. We hypothesise that PE deranges fetal haematopoiesis and subsequently UCBC populations. Therefore, the objective of this study was to investigate newborn umbilical cord blood cell populations in early- (EOPE) and late-onset PE (LOPE). A secondary cohort analysis in The Rotterdam Periconceptional Cohort was conducted comprising 23 PE cases, including 11 EOPE and 12 LOPE, and 195 controls, including 153 uncomplicated and 23 fetal growth restriction- and 19 preterm birth complicated controls. UCBC counts and differentials were quantified by flow cytometry and analysed as main outcome measures. Multivariable regression analysis revealed associations of EOPE with decreased leucocyte- (monocytes, neutrophils, eosinophils, immature granulocytes) and thrombocyte counts and increased NRBC counts (all p<0.05). EOPE remained associated with neutrophil- (β-0.92, 95%CI -1.27,-0.57, p<0.001) and NRBC counts (β1.11, 95%CI 0.27,1.95, p=0.010) after adjustment for gestational age and birth weight. LOPE did not reveal any significant association. We conclude that derangements of fetal haematopoiesis, in particular of neutrophil- and NRBC counts, are associated with EOPE only, with a potential impact for future health of the offspring. This heterogeneity in UCBC should be considered as confounder in epigenetic association studies examining EOPE.
Collapse
Affiliation(s)
- Emilie M Herzog
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - Alex J Eggink
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - Marten van der Zee
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - Jacqueline Lagendijk
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - Sten P Willemsen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands; Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - Robert de Jonge
- Department of Clinical Chemistry, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| | - Regine P M Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands; Department of Paediatrics, division of Neonatology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| |
Collapse
|
26
|
Vaughan J, Alli N, Mannaru K, Sedick Q. Refining peripheral blood smear review rules for neonatal inpatients in a South African academic laboratory. Int J Lab Hematol 2016; 38:347-51. [PMID: 27087063 DOI: 10.1111/ijlh.12491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 03/02/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Peripheral blood smear review (PBSR) is a labour-intensive test, and skilled morphologists are in short supply. It is therefore helpful for laboratories to establish rules for PBSR to improve laboratory efficiency. Previously published guidelines in this regard are useful, but make few recommendations specific to neonates. Neonatal blood is characterized by several peculiarities which would be considered pathological if present in adults. Consequently, smear review rules (SRR) are often triggered in neonates without significant value being added on review. This study aimed to assess and fine-tune the SRR triggered in neonatal samples in order to improve laboratory efficiency. METHODS Full blood counts collected from 188 neonatal inpatients of the Chris Hani Baragwanath Academic Hospital in South Africa were retrospectively reviewed, the triggered rules documented, and the value added on PBSR determined. RESULTS Smear review rules were triggered in 148 (78.7%) samples, with significant morphological abnormalities identified in 84 (54.4%), and a false-positive rate of 34.0%. In patients with unhelpful review, the commonest rules triggered were the flags querying the presence of abnormal lymphocytes, blasts or nucleated red blood cells. When one or more of these flags were triggered in the absence of any other SRR, PBSR was always noncontributory. Disregarding these flags in the current cohort would reduce both the review and the false-positive rates by >20% without increasing the false-negative rate. CONCLUSION False-positive smear review is common in neonates, and minor modifications to SRR can substantially reduce the smear review rate without increasing the false-negative rate.
Collapse
Affiliation(s)
- J Vaughan
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa.,Department of Haematology, National Health Laboratory Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - N Alli
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa.,Department of Haematology, National Health Laboratory Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - K Mannaru
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | - Q Sedick
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
27
|
Brown GP, Shine R. Maternal body size influences offspring immune configuration in an oviparous snake. ROYAL SOCIETY OPEN SCIENCE 2016; 3:160041. [PMID: 27069670 PMCID: PMC4821281 DOI: 10.1098/rsos.160041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
Like most ectothermic vertebrates, keelback snakes (Tropidonophis mairii) do not exhibit parental care. Thus, offspring must possess an immune system capable of dealing with challenges such as pathogens, without assistance from an attendant parent. We know very little about immune system characteristics of neonatal reptiles, including the magnitude of heritability and other maternal influences. To identify sources of variation in circulating white blood cell (WBC) concentrations and differentials, we examined blood smears from 246 hatchling snakes and their field-caught mothers. WBC concentrations were lower in hatchlings than in adults, and hatchlings had more basophils and fewer azurophils than adults. A hatchling keelback's WBC differential was also influenced by its sex and body size. Although hatchling WBC measures exhibited negligible heritability, they were strongly influenced by maternal body size and parasite infection (but not by maternal body condition, relative clutch mass or time in captivity). Larger mothers produced offspring with more azurophils and fewer lymphocytes. The mechanisms and consequences of WBC variation are currently unknown, but if these maternal effects enhance offspring fitness, the impact of maternal body size on reproductive success may be greater than expected simply from allometric increases in the numbers and sizes of progeny.
Collapse
|
28
|
Becker PH, Fenneteau O, Da Costa L. Performance evaluation of the Sysmex XN-1000 hematology analyzer in assessment of the white blood cell count differential in pediatric specimens. Int J Lab Hematol 2015; 38:54-63. [PMID: 26407903 DOI: 10.1111/ijlh.12436] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/13/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The automated XN-1000 hematology analyzer enables to perform a blood cell count and a leukocyte differential. When abnormal cells were detected, a flag was generated by the analyzer and a manual microscopic examination of the corresponding blood film was performed. METHODS We compared the white blood cell differentials provided by the automated hematology analyzer XN-1000 in a pediatric population (n = 765) with those obtained through microscopic examination by cytologists and those obtained using a previous version of this analyzer, the XE-2100. Leukocytes count as well as flags sensitivity and specificity was analyzed. RESULTS The leukocytes count provided by the analyzer is in good accordance with the differential obtained by manual count in children older than 3 months. The sensitivity for blast detection is 99% and the detection of reactive cells is 63%. The flag specificity remains low (<35%) for blood samples collected from infants between 8 days and 2 years of age, but increases up to 67% thereafter. The results obtained with the XN-1000 analyzer show an improvement in comparison with those obtained with the XE-2100 analyzer. CONCLUSION The automated WBC differential provided by the XN-1000 analyzer in the pediatric setting is accurate, but a meticulous microscopic examination of blood smears remains necessary for infants up to 3 months of age to validate the analyzer flags.
Collapse
Affiliation(s)
- P-H Becker
- Service d'Hématologie Biologique, Hôpital R. Debré, AP-HP, Paris, France
| | - O Fenneteau
- Service d'Hématologie Biologique, Hôpital R. Debré, AP-HP, Paris, France
| | - L Da Costa
- Service d'Hématologie Biologique, Hôpital R. Debré, AP-HP, Paris, France.,Université Paris Diderot Sorbonne Paris Cité, Paris, France.,CRI, Faculté Bichat-Claude Bernard, INSERM U1149, Paris, France.,Laboratoire d'excellence GR-Ex, Paris, France
| |
Collapse
|
29
|
Lee J, Kim SY, Lee W, Han K, Sung IK. Cell population data in neonates: differences by age group and associations with perinatal factors. Int J Lab Hematol 2015; 37:606-12. [PMID: 25944264 DOI: 10.1111/ijlh.12366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/25/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cell population data (CPD) describe physical parameters of white blood cell subpopulations and are reported to be of some value in the diagnosis of sepsis in neonates. Before using the CPD for diagnosing sepsis, the baseline features of the CPD distribution in healthy neonates should be clarified. The aim of this study was to compare the CPD distributions of healthy neonates and other age groups and to identify perinatal factors that are associated with changes in the CPD distribution of healthy neonates. METHODS The CPD distribution of 69 samples from term neonates was compared with adolescents and adults. The CPD distribution of 163 samples from healthy neonates was analyzed in association with perinatal factors, including gestational age, chronologic age, birthweight, delivery mode, premature rupture of membranes, diabetes, and pregnancy-induced hypertension. RESULTS The CPD distribution for term neonates was significantly different from those in adolescents and adults. The mean lymphocyte volume showed a negative correlation with gestational age at birth (r = -0.305; P < 0.01). The mean neutrophil volume was smaller in the cesarean section group than in the normal delivery group. The small for gestational age (SGA) group had smaller mean neutrophil volume and mean monocyte volume than the appropriate for gestational age group. CONCLUSION The CPD distribution of healthy neonates differed from those of adolescents or adults, and the differences were associated with gestational age, delivery mode, and being SGA.
Collapse
Affiliation(s)
- J Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - S Y Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - W Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - K Han
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - I K Sung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
30
|
|
31
|
Chabot-Richards DS, George TI. Leukocytosis. Int J Lab Hematol 2014; 36:279-88. [PMID: 24750674 DOI: 10.1111/ijlh.12212] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 02/05/2014] [Indexed: 02/05/2023]
Abstract
An increased white blood cell count, or leukocytosis, is a common laboratory finding. Appropriate specimen evaluation depends on which lineages are increased and the morphologic findings on peripheral blood smear review to guide further testing. The presence of blasts is concerning for acute leukemia and may require bone marrow biopsy. Lymphocytosis may be morphologically divided into polymorphic and monomorphic populations. Polymorphic lymphocytosis is most consistent with a reactive process, while monomorphic populations are concerning for lymphoproliferative neoplasm. The differential can be further narrowed based on morphologic findings. Myeloid leukocytosis can occur in a number of reactive conditions as well as myeloid malignancies. The types of cells present and morphology can help to guide additional workup. This study provides guidance for the appropriate evaluation and further workup of leukocytosis.
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW The aim is to review normal blood neutrophil concentrations and the clinical approach to neutropenia in the neonatal period. A literature search on neonatal neutropenia was performed using the databases PubMed, EMBASE, and Scopus, and the electronic archive of abstracts presented at the annual meetings of the Pediatric Academic Societies. RECENT FINDINGS The review summarizes current knowledge on the causes of neutropenia in premature and critically ill neonates, focusing on common causes such as maternal hypertension, neonatal sepsis, twin-twin transfusion, alloimmunization, and hemolytic disease. The article provides a rational approach to diagnosis and treatment of neonatal neutropenia, including current evidence on the role of recombinant hematopoietic growth factors. SUMMARY Neutrophil counts should be carefully evaluated in premature and critically ill neonates. Although neutropenia is usually benign and runs a self-limited course in most neonates, it can be prolonged, and it constitutes a serious deficiency in antimicrobial defense in some infants.
Collapse
|
33
|
Non-invasive MRI measurements of venous oxygenation, oxygen extraction fraction and oxygen consumption in neonates. Neuroimage 2014; 95:185-92. [DOI: 10.1016/j.neuroimage.2014.03.060] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 03/08/2014] [Accepted: 03/22/2014] [Indexed: 11/17/2022] Open
|
34
|
O'Brien MA, McMichael MA, Le Boedec K, Lees G. Reference intervals and age-related changes for venous biochemical, hematological, electrolytic, and blood gas variables using a point of care analyzer in 68 puppies. J Vet Emerg Crit Care (San Antonio) 2014; 24:291-301. [PMID: 24698011 DOI: 10.1111/vec.12162] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/29/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the reference interval for various venous analyte concentrations using a point-of-care (POC) analyzer in healthy, 4-84-day-old puppies and identify any age-specific variations in the values as compared with adults. DESIGN A prospective cohort study. SETTING University teaching hospital. ANIMALS Clinically healthy dogs; 68 puppies and 30 adults. MEASUREMENTS AND MAIN RESULTS Samples were collected by jugular venipuncture from 68 clinically healthy puppies at 4, 10, 12, 16, 28, 70, 77, and 84 days of age and once each from 30 clinically healthy adult dogs. Blood samples (n = 287) were analyzed within 5 minutes of collection using an automated POC analyzer. Reference intervals for puppies at various ages were estimated using a bootstrap sampling approach. The analytes that were closest to the adult values were pH and bicarbonate. On days 4 and 10 the pH for puppies was higher than the adults while the HCO3 was higher than the adults only on day 4. HCT on day 4 approximated adult values but fell to a nadir on day 28 before rising toward adult levels. At all time points, sodium, chloride, and ionized magnesium concentrations were lower than adult values, and potassium and ionized calcium were higher than adult values. Glucose was similar to adult values on day 4 but was above adult values at all other time points. Blood urea nitrogen (BUN) was higher in puppies until day 28 when it became lower than in adults. BUN levels remained lower than adults through day 84. CONCLUSIONS Variations exist between puppies and adults for venous POC analyzer results. Adult reference intervals should not be used for puppies as this might cause misinterpretation of the results.
Collapse
Affiliation(s)
- Mauria A O'Brien
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Illinois, Urbana, IL, 61802
| | | | | | | |
Collapse
|
35
|
Engel SM, Joubert BR, Wu MC, Olshan AF, Håberg SE, Ueland PM, Nystad W, Nilsen RM, Vollset SE, Peddada SD, London SJ. Neonatal genome-wide methylation patterns in relation to birth weight in the Norwegian Mother and Child Cohort. Am J Epidemiol 2014; 179:834-42. [PMID: 24561991 DOI: 10.1093/aje/kwt433] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Although epigenetic regulation plays a critical role in embryonic development, few studies have examined the relationship of epigenome-wide methylation with fetal growth. Using the Infinium HumanMethylation450 BeadChip (Illumina, Inc., San Diego, California) in a substudy of 1,046 infants from the Norwegian Mother and Child Cohort Study (MoBa) enrolled between 1999 and 2008, we examined epigenome-wide cord blood DNA methylation in relation to birth weight. In multivariable-adjusted robust linear regression models, we identified differential methylation at 19 cytosine-guanine dinucleotides (CpGs) associated with either decreased (AT-rich interactive domain 5B (MRF1-like) (ARID5B), 2 CpGs) or increased (x-ray repair complementing defective repair in Chinese hamster cells 3 (XRCC3), 4 CpGs) birth weight. ARID5B knockout mice have less adipose tissue and significantly lower weight in the postnatal period. XRCC3 plays a key role in the maintenance of chromosome stability and the repair of DNA damage. Although there are fewer data on the other implicated genes, many of these genes have been shown to have roles in developmental processes. This constitutes the largest and most robust study of birth weight using an epigenome-wide methylation platform and offers potential insights into epigenetic mechanisms of fetal growth.
Collapse
|
36
|
De Vis JB, Hendrikse J, Groenendaal F, de Vries LS, Kersbergen KJ, Benders MJNL, Petersen ET. Impact of neonate haematocrit variability on the longitudinal relaxation time of blood: Implications for arterial spin labelling MRI. NEUROIMAGE-CLINICAL 2014; 4:517-25. [PMID: 24818078 PMCID: PMC3984444 DOI: 10.1016/j.nicl.2014.03.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/13/2014] [Accepted: 03/14/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The longitudinal relaxation time of blood (T 1b) is influenced by haematocrit (Hct) which is known to vary in neonates. The purpose of this study was threefold: to obtain T 1b values in neonates, to investigate how the T 1b influences quantitative arterial spin labelling (ASL), and to evaluate if known relationships between T 1b and haematocrit (Hct) hold true when Hct is measured by means of a point-of-care device. MATERIALS AND METHODS One hundred and four neonates with 120 MR scan sessions (3 T) were included. The T 1b was obtained from a T 1 inversion recovery sequence. T 1b-induced changes in ASL cerebral blood flow estimates were evaluated. The Hct was obtained by means of a point-of-care device. Linear regression analysis was used to investigate the relation between Hct and MRI-derived R1 of blood (the inverse of the T 1b). RESULTS Mean T 1b was 1.85 s (sd 0.2 s). The mean T 1b in preterm neonates was 1.77 s, 1.89 s in preterm neonates scanned at term-equivalent age (TEA) and 1.81 s in diseased neonates. The T 1b in the TEA was significantly different from the T 1b in the preterm (p < 0.05). The change in perfusion induced by the T 1b was -11% (sd 9.1%, p < 0.001). The relation between arterial-drawn Hct and R1b was R1b = 0.80 × Hct + 0.22, which falls within the confidence interval of the previously established relationships, whereas capillary-drawn Hct did not correlate with R1b. CONCLUSION We demonstrated a wide variability of the T 1b in neonates and the implications it could have in methods relying on the actual T 1b as for instance ASL. It was concluded that arterial-drawn Hct values obtained from a point-of-care device can be used to infer the T 1b whereas our data did not support the use of capillary-drawn Hct for T 1b correction.
Collapse
Key Words
- ASL, arterial spin labelling
- Arterial spin labelling
- Blood T1
- CBF, cerebral blood flow
- CBF1.6, cerebral blood flow quantified with a T1b of 1.6 s
- CBF1.85, cerebral blood flow quantified with a T1b of 1.85 s
- CBFcor, cerebral blood flow quantified with the corrected T1b
- CBFmean, cerebral blood flow quantified with the mean T1b found in our study
- Cerebral blood flow
- Haematocrit
- Hct, haematocrit
- Hctad, haematocrit measured on an arterial-drawn blood sample
- Hctcd, haematocrit measured on a capillary-drawn blood sample
- MRI
- MRI, magnetic resonance imaging
- NPD, normalized perfusion difference
- Neonates
- PCA, postconceptional age
- PNA, postnatal age
- POCT, point-of-care test
- R1b, longitudinal relaxation rate constant of blood
- T1b, longitudinal relaxation time of blood
- TEA, term-equivalent age
Collapse
Affiliation(s)
- J B De Vis
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Groenendaal
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K J Kersbergen
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J N L Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E T Petersen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands ; Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
37
|
Biochemical signs of impaired cobalamin function do not affect hematological parameters in young infants: results from a double-blind randomized controlled trial. Pediatr Res 2013; 74:327-32. [PMID: 23770919 DOI: 10.1038/pr.2013.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/16/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Whereas iron deficiency is considered the leading cause of anemia in infants, cobalamin deficiency is foremost characterized by developmental delay, and the typical macrocytic anemia is confined to severe and longstanding cobalamin deficiency in this age group. Hematological parameters were investigated in 4-mo-old infants with biochemical signs of impaired cobalamin function who participated in a randomized controlled cobalamin intervention study at 6 wk. METHODS One hundred and seven infants were randomly assigned to receive either an intramuscular injection with 400 μg cobalamin or no intervention at 6 wk. Hematological parameters, and cobalamin and folate status were determined at inclusion and 4 mo. RESULTS Cobalamin supplementation improved all markers of impaired cobalamin function but had no effect on hematological cell counts at 4 mo (P > 0.18). Signs indicative of an iron-restricted erythropoiesis were observed at 6 wk and 4 mo. At 4 mo, the strongest predictors of low iron status were male gender and a high percentage weight increase from birth. CONCLUSION In infants with biochemical signs of impaired cobalamin function, supplementation does not improve hematological cell counts. Variations in erythrocyte parameters seem to be foremost associated with iron status in this age group.
Collapse
|
38
|
Grecu DS, Paulescu E. Quality in post-analytical phase: indirect reference intervals for erythrocyte parameters of neonates. Clin Biochem 2013; 46:617-21. [PMID: 23458859 DOI: 10.1016/j.clinbiochem.2013.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/18/2013] [Accepted: 02/20/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study aims to gain an estimation of the reference intervals for erythrocyte parameters of neonates in the venous blood, in their first day of life, aiming to achieve quality assurance in post-analytical phase according to the requirement of the ISO standard 15189:2007: Medical laboratories-particular requirements for quality and competence. DESIGN AND METHODS The study was performed on a group of 845 subjects selected from the laboratory database. The blood test was performed with the Nihon Celltac F automatic hematology analyzer. In order to find the reference interval, the Hoffmann indirect method was used to process the study group. RESULTS The results give the reference intervals for red blood cell (RBC=3.45-5.26×10(6)/μL), hemoglobin (HGB=12.5-19.48g/dL), hematocrit (HCT=37.18-55.65%), mean cell volume (MCV=99.63-111.92fL), mean corpuscular hemoglobin (MCH=33.55-39.28pg) and mean corpuscular hemoglobin concentration (MCHC=32.33-36.23g/dL), along with the corresponding confidence intervals. CONCLUSIONS Neonates are a special category of population to which the application of the direct method for determining the reference intervals is difficult and raises ethical issues. Thus, the indirect method is a reasonable alternative. The reported approach is easy to apply and accessible to any laboratory.
Collapse
Affiliation(s)
- Daniela Stefania Grecu
- University of Medicine and Pharmacy Victor Babes Timisoara, Biochemistry and Pharmacology Department, 2, Eftimie Murgu Square, 300041 Timisoara, Romania
| | | |
Collapse
|
39
|
Pereira-Cunha FG, Duarte ASS, Costa FF, Saad STO, Lorand-Metze I, Luzo ACM. Viability of umbilical cord blood mononuclear cell subsets until 96 hours after collection. Transfusion 2013; 53:2034-42. [PMID: 23320473 DOI: 10.1111/trf.12078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/05/2012] [Accepted: 11/12/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Umbilical cord blood (UCB) is a good source of hematopoietic stem cells for transplantation and cell therapy. In 2006, the Brazilian Public Network of Cord Blood Banks was founded; however, because our country is large, logistic problems could hamper the collection of numerous samples. Our aim was to evaluate the viability of several UCB cell subsets until 96 hours after collection, to examine whether this delay would be acceptable for processing and freezing the samples. STUDY DESIGN AND METHODS Two experiments were performed: in the first one, volume reduction of the UCB units was carried out before analysis. In the second one, analysis was carried out with no previous manipulation. Samples were stored at room temperature and one aliquot was taken daily for analysis. We examined CD34+ cell, B-cell precursor, mature B and T lymphocyte, monocyte, granulocyte, and mesenchymal stem cell (MSCs) concentrations. RESULTS Thirty-six UCB units were analyzed. CD34+ cells and mature T lymphocytes increased (viability 99%). Mature B lymphocytes and MSCs decreased, maintaining viability. Granulocytes decreased with loss of viability. Monocytes and immature B lymphocytes remained stable. Clonogenic assays showed a decrease in colony-forming unit (CFU) number in UCB units stored for 96 hours. CONCLUSION UCB manipulation did not influence cell viability. All cell subsets remained viable until 96 hours after collection. CD34+ cells and T lymphocytes increased, probably due to the loss of other subsets. CFU growth during the period analyzed and confirmed stem cell functionality, despite the decrease at 96 hours. Results demonstrated that UCB units could probably be processed up to 96 hours after collection.
Collapse
Affiliation(s)
- Fernanda G Pereira-Cunha
- Flow Cytometry Laboratory and Public Umbilical Cord Blood Bank of Haematology Hemotherapy Center, INCT do Sangue, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | | | | | | |
Collapse
|
40
|
Tonbul A, Tayman C, Catal F, Kara S, Tatli MM. Red cell distribution width (RDW) in the newborn: normative data. J Clin Lab Anal 2012; 25:422-5. [PMID: 22086796 DOI: 10.1002/jcla.20496] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM To evaluate the normal range of red blood cell distribution width (RDW) in term and preterm newborns dependent on gestational age. MATERIAL AND METHODS A total of 1,594 preterm and term neonates were admitted to our neonatology department. Infants were divided into two groups according to their gestational age. Group 1 consisted of infants with ≤34 weeks of gestation; group 2 consisted of infants with ≥35 weeks of gestation. Infants in Groups I and II were subdivided according to their gestational age. Gestational age, birth weight, sex, hemoglobin and hematocrit, MCV levels of all newborns were recorded, and RDW was compared between the groups. RESULTS A total of 1,594 newbornswere enrolled in the study. Group 1 (≤34 weeks) consisted of 725 newborns and Group 2 (≥35 weeks) consisted of 869 newborns. The mean normal range of RDW in Group 1 was 17.8 ± 2.1 and of group II was 16.7 ± 1.6 (P<0.05). The normal range for RDW values at 32-34 weeks was higher than at 35-36 gestational weeks, and at 37-42 weeks (P = 0.002 and 0.003). CONCLUSION RDW values at ≤34 weeks in newborns are higher than at ≥35 weeks. This may be useful in the differential diagnosis of neonatal hematologic diseases together with other red cell parameters.
Collapse
Affiliation(s)
- Alparslan Tonbul
- Department of Neonatology, Fatih University Faculty of Medicine, Ankara, Turkey
| | | | | | | | | |
Collapse
|
41
|
Cheng Y, Thomas A, Mardini F, Bianchi SL, Tang JX, Peng J, Wei H, Eckenhoff MF, Eckenhoff RG, Levy RJ. Neurodevelopmental consequences of sub-clinical carbon monoxide exposure in newborn mice. PLoS One 2012; 7:e32029. [PMID: 22348142 PMCID: PMC3277503 DOI: 10.1371/journal.pone.0032029] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 01/18/2012] [Indexed: 12/13/2022] Open
Abstract
Carbon monoxide (CO) exposure at high concentrations results in overt neurotoxicity. Exposure to low CO concentrations occurs commonly yet is usually sub-clinical. Infants are uniquely vulnerable to a variety of toxins, however, the effects of postnatal sub-clinical CO exposure on the developing brain are unknown. Apoptosis occurs normally within the brain during development and is critical for synaptogenesis. Here we demonstrate that brief, postnatal sub-clinical CO exposure inhibits developmental neuroapoptosis resulting in impaired learning, memory, and social behavior. Three hour exposure to 5 ppm or 100 ppm CO impaired cytochrome c release, caspase-3 activation, and apoptosis in neocortex and hippocampus of 10 day old CD-1 mice. CO increased NeuN protein, neuronal numbers, and resulted in megalencephaly. CO-exposed mice demonstrated impaired memory and learning and reduced socialization following exposure. Thus, CO-mediated inhibition of neuroapoptosis might represent an important etiology of acquired neurocognitive impairment and behavioral disorders in children.
Collapse
Affiliation(s)
- Ying Cheng
- Division of Anesthesiology and Pain Medicine, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Adia Thomas
- Division of Anesthesiology and Pain Medicine, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Feras Mardini
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Shannon L. Bianchi
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Junxia X. Tang
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jun Peng
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Huafeng Wei
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Maryellen F. Eckenhoff
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Roderic G. Eckenhoff
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Richard J. Levy
- Division of Anesthesiology and Pain Medicine, Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
- * E-mail:
| |
Collapse
|
42
|
Park SH, Chi HS, Choi MO, Park BG, Jang S, Park CJ. Improved turnaround time for neonatal hematology profile tests (complete blood count) using a new microcollection tube. Clin Chem Lab Med 2011; 49:1083-5. [PMID: 21410415 DOI: 10.1515/cclm.2011.174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
43
|
Abstract
Rapid evaluation and intervention is a requirement and a characteristic of patient management in neonatal intensive care units, and this applies for equine neonates also. Appropriate interventions are based on solid knowledge of age, maturity, and species-specific differences in reference ranges. Point-of-care (POC) testing devices speedup decision making regarding treatments and interventions. However, there are potential limitations of these devices when applied to age groups and species beyond those they were specifically developed for. This article discusses the age-specific differences in the reference ranges and the potential limitations of POC devices currently used, which may affect delivery of care.
Collapse
|
44
|
Kost GJ, Hale KN. Global trends in critical values practices and their harmonization. Clin Chem Lab Med 2011; 49:167-76. [DOI: 10.1515/cclm.2011.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|