Venous and arterial hematologic profiles of very low birth weight infants. European Multicenter rhEPO Study Group

The role of early-onset-sepsis in the neurodevelopment of very low birth weight infants

AIMS

The study investigated a putative association between early-onset-sepsis (EOS) and poor neurodevelopmental outcomes at 2 years corrected age in very low birth weight infants.

METHODS

This was a single-center cohort study on infants weighing less than 1500 g with a gestational age below 35 weeks at birth born between 2008 and 2011. Neurodevelopmental outcomes were assessed at follow-up with the Bayley Scales of Infant Development-II. EOS was defined as either culture-proven EOS or clinical EOS using blood culture, CrP levels, and clinical symptoms and treatment. Neurodevelopmental impairment (NDI) was defined as one or more of the following: Mental Developmental Index (MDI) and/or Psychomotor Developmental Index (PDI) scores lower than 70; presence of cerebral palsy.

RESULTS

Of 405 eligible newborns in the study period 166 were included. Two had culture-proven and 29 clinical EOS. Median MDI scores in patients with EOS were 96 (IQR: 86-106) and in the control group 94 (84-106, p = 0.77). PDI scores in patients with EOS were 96 (86-106) and in the control group 99,5 (92-103, p = 0.03). Of infected patients 7/31 (24%) showed NDI as defined, whereas only 11/135 (8%) showed NDI in the control group (OR 3.3, p = 0.03). Multiple regression analyses identified chorioamnionitis and poor CRIB-Scores as individual risk factors for MDI or PDI values < 70.

CONCLUSION

In our study, EOS among VLBW-infants significantly impaired the neurodevelopment at 2 years corrected age. As shown in previous reports infection continues to be a problem and strategies for a reduction need further improvement.

Efficacy and safety of high and low dose recombinant human erythropoietin on neurodevelopment of premature infants: A meta-analysis

BACKGROUND

To evaluate the effect of recombinant human erythropoietin (rhEPO) in nervous system of premature infants including different dosage.

METHODS

The multiple databases like Pubmed, Embase, Cochrane databases and China National Knowledge Database were used to search for the relevant studies, and full-text articles involved in the evaluation on effect of rhEPO for neurodevelopment among premature infants. Review Manager 5.2 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted.

RESULTS

Finally, 10 eligible studies were eventually satisfied the included criteria. The results showed that rhEPO was much higher than placebo group in composite cognitive score (MD = 5.89, 95% confidential interval {CI} [1.95, 9.82], P = .003; I2 = 89%), there was no significant difference between rhEPO and placebo groups (RR = 0.93, 95% CI [0.60, 1.43], P = .74; I2 = 51%) and no difference in neurodevelopmental impairment between rhEPO and placebo was insignificant (RR = 0.55 95% CI [0.30, 1.02], P = .06). Composite cognitive score in high dose rhEPO was much higher than placebo group (MD = 10.39, 95% CI [8.84, 11.93], P < .0001, I2 = 0%) and low dose rhEPO also had higher composite cognitive score than placebo group (MD = 2.58, 95% CI [0.80, 4.37], P = .004, I2 = 11%). Limited publication bias was observed in this study.

CONCLUSION

Recombinant human erythropoietin might be a promotor for neurodevelopment among premature infants with limited adverse events.

Reference Ranges for Hemoglobin and Hematocrit Levels in Neonates as a Function of Gestational Age (22⁻42 Weeks) and Postnatal Age (0⁻29 Days): Mathematical Modeling

Hematological values of neonates need to be interpreted taking into account the fact that the reference ranges depend on the age of the neonate. We aimed to derive two general mathematical models for reference ranges for hemoglobin concentration (cHb) and hematocrit (Hct) levels in neonates as a function of gestational age (GA) and postnatal age (PNA), since it is known that GA and PNA are independent factors determining cHb and Hct. For this purpose, cHb and Hct values from the data set of Henry and Christensen (2015, Clin. Perinatol., 42, 483⁻497) from about 100,000 neonates (GA: 22⁻42 weeks, PNA: 0⁻28 days) were used and general models with two quadratic functions were derived. To the best of our knowledge, the models we have developed are the first published ones to provide reference ranges for cHb and Hct for neonates incorporating the parallel dependence on GA and PNA.

Effect of Delayed Cord Clamping on Hematocrit, and Thermal and Hemodynamic Stability in Preterm Neonates: A Randomized Controlled Trial

OBJECTIVE

To evaluate the short term clinical effects of delayed cord clamping in preterm neonates.

DESIGN

Randomized controlled trial.

SETTING

A tertiary care neonatal unit from October 2013 to September 2014.

PARTICIPANTS

78 mothers with preterm labor between 27 to 316/7 weeks gestation.

INTERVENTION

Early cord clamping (10 s), delayed cord clamping (60 s) or delayed cord clamping (60 s) along with intramuscular ergometrine (500 µg) administered to the mother.

MAIN OUTCOME MEASURES

Primary: hematocrit at 4 h after birth; Secondary: temperature on admission in neonatal intensive care unit, blood pressure (non-invasive) at 12 h, and urinary output for initial 72 h.

RESULTS

Mean (SD) hematocrit at 4 h of birth was 58.9 (2.4)% in delayed cord clamping group, and 58.7 (2.1) % in delayed cord clamping with ergometrine group as compared to 47.6 (1.3) % in early cord clamping group. Mean (SD) temperature on admission in NICU was 35.8 (0.2)ºC, 35.8 (0.3)ºC, and 35.5 (0.3)ºC, respectively in these three groups. The mean (SD) non-invasive blood pressure at 12 h of birth was 45.8 (7.0) mmHg, 45.8 (9.0) mmHg, and 35.5 (8.6) mmHg, respectively in these three groups. Mean (SD) urinary output on day 1 of life was 1.1 (0.2) mL/kg/h, 1.1 (0.2) mL/kg/hr and 0.9 (0.2) ml/kg/h, respectively.

CONCLUSION

In preterm neonates delayed cord clamping along with lowering the infant below perineum or incision site and administration of ergometrine to mother has significant benefits in terms of increase in hematocrit, higher temperature on admission, and higher blood pressure and urinary output during perinatal transition.

Safety of Early High-Dose Recombinant Erythropoietin for Neuroprotection in Very Preterm Infants

OBJECTIVE

To investigate the safety and short term outcome of high dose recombinant human erythropoietin (rhEpo) given shortly after birth and subsequently over the first 2 days for neuroprotection to very preterm infants.

STUDY DESIGN

Randomized, double masked phase II trial. Preterm infants (gestational age 26 0/7-31 6/7 weeks) were given rhEpo (nt = 229; 3000 U/kg body weight) or NaCl 0.9% (nc = 214) intravenously at 3, 12-18, and 36-42 hours after birth.

RESULTS

There were no relevant differences between the groups for short-term outcomes such as mortality, retinopathy of prematurity, intraventricular hemorrhage, sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia. At day 7-10, we found significantly higher hematocrit values, reticulocyte, and white blood cell counts, and a lower platelet count in the rhEpo group.

CONCLUSIONS

Early high-dose rhEpo administration to very premature infants is safe and causes no excess in mortality or major adverse events.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00413946.

Alteration in regional tissue oxygenation of preterm infants during placement in the semi-upright seating position

We investigated whether the cerebral (rSO2-C %) and renal (rSO2-R %) tissue oxygenation of preterm infants is altered by repositioning from the supine to semi-upright position for pre-discharge car seat testing. Near-infrared spectroscopy was used to measure rSO2-C and rSO2-R, which were recorded simultaneously with vital signs in 15 preterm infants for 30 minutes in supine, 60 minutes in the semi-upright (at 45 degrees in a car seat), and 30 minutes in the post-semi-upright (supine) position. Changes in rSO2-C and SO2-R were mostly within 1 Standard Deviation (SD) of baseline mean levels in the supine position. Decrease in rSO2-C and rSO2-R (more than 1SD below baseline mean) was recorded in 26.7% and 6.6% of infants respectively, which persisted even after adjustment for variation in heart and respiratory rate, and pulse oximeter measured oxygen saturation (P, 0.0001). Re-positioning the infants from the car seat to supine position was associated with normalization of the rSO2-C. Alteration in rSO2-C and rSO2-R in a car seat was independent from the gestational and post-conception age, weight and presence of anemia. We concluded that approximately one-third of preterm infants show minor reduction of cerebral tissue oxygenation in the semi-upright (car seat) position.

Platelets in neonates: central mediators in haemostasis, antimicrobial defence and inflammation

Platelets are not only centrally involved in haemostasis, but also in antimicrobial defence and inflammation. Since evaluation of platelet physiology in the particular patient group of preterm and term neonatal infants is highly restricted for ethical reasons, there are hardly any data available in healthy and much less in extremely immature or ill neonates. By summarising current knowledge and addressing both platelet researchers and neonatologists, we describe neonatal platelet count and morphology, report on previous analyses of neonatal platelet function in primary haemostasis and provide insights into recent advances in platelet immunology that considerably impacts our clinical view on the critically ill neonatal infant. We conclude that neonatal platelets, originating from liver megakaryocytes, substantially differ from adult platelets and may play a pivotal role in the pathophysiology of neonatal sepsis or intraventricular haemorrhage, both complications which seriously augment perinatal morbidity and mortality.

Late-onset neutropenia: defining limits of neutrophil count in very low birth weight infants

OBJECTIVE

To evaluate the incidence, onset, duration, characteristics and importance of late-onset neutropenia (defined as absolute neutrophil count<1500 μl(-1) at 3 weeks of age or later) in a group of very low birth weight (VLBW) infants.

STUDY DESIGN

Routine complete blood cell counts (CBCs) obtained from VLBW infants over a period of 7 years were gathered retrospectively, including those of newborns with weekly CBCs taken over a duration of at least 3 weeks. Data were obtained from between January 2003 and December 2009.

RESULT

CBCs of 399 newborns were included. Values were obtained from birth to 36 weeks of postnatal age. Late-onset neutropenia was observed in 259 cases (65%). Neutropenic infants had a mean of 0.5 weeks lower gestational age. Late-onset neutropenia was more frequent in children with intraventricular hemorrhage but not in patients who received erythropoietin. The median age of neutropenia onset was 7 weeks in extremely low birth weight infants and 6 weeks in VLBW infants. The fifth percentile of neutrophils between weeks 3 and 4 was 1280 μl(-1) and between weeks 13 and 15 was 500 μl(-1). The average duration was 2 weeks with normalized values after 18 weeks.

CONCLUSION

A neutrophil count <1500 μl(-1) after the third week of life is frequently observed in VLBW infants and should not be used as a lower reference limit. The fifth percentile varies according to postnatal age from around 1300 μl(-1) in week 4 of life, decreasing to a nadir of 500 μl(-1) between 3 and 4 months of age. Values normalize in the first year of life.

Preventing germinal matrix layer rupture and intraventricular hemorrhage

The etiology of intraventricular hemorrhage (IVH) in extremely low birth weight preterm infants is multifactorial with circulatory instability and hemostasis being preeminent. This study sought to determine if the germinal matrix layer remained intact when platelets were above 200 × 10(9)/L, a near normal level, and fell below that when IVH occurred. This was a retrospective study of platelets and head ultrasounds (HUS) in infants 23-28 weeks gestation. Analyses were descriptive, one way analysis of variance, Pearson Chi-square tests, and t-tests. Platelet counts and HUS were linked in 114 infants during the first 3 days when 90% of IVHs occur. Mean platelet levels were >200 × 10(9)/L in 68% of infant 23-24 weeks gestation and 78% of those 25-26 weeks when there were no IVHs. These findings, if confirmed, suggest that improving hemostasis in high risk preterm infants by keeping platelet levels >200 × 10(9)/L may maintain the integrity of the germinal matrix layer and prevent IVHs.

Nonpharmacological, blood conservation techniques for preventing neonatal anemia--effective and promising strategies for reducing transfusion

The development of anemia after birth in very premature, critically ill newborn infants is a universal well-described phenomenon. Although preventing anemia in this population, along with efforts to establish optimal red blood cell (RBC) transfusion and pharmacologic therapy continue to be actively investigated, the present review focuses exclusively on nonpharmacological approaches to the prevention and treatment of neonatal anemia. We begin with an overview of topics relevant to nonpharmacological techniques. These topics include neonatal and fetoplacental hemoglobin levels and blood volumes, clinical and laboratory practices applied in critically ill neonates, and current RBC transfusion practice guidelines. This is followed by a discussion of the most effective and promising nonpharmacological blood conservation strategies and techniques. Fortunately, many of these techniques are feasible in most neonatal intensive care units. When applied together, these techniques are more effective than existing pharmacotherapies in significantly decreasing neonatal RBC transfusions. They include increasing hemoglobin endowment and circulating blood volume at birth; removing less blood for laboratory testing; and optimizing nutrition.

Association between neonatal iron overload and early human brain development in premature infants

BACKGROUND

Emerging evidence suggests that excess iron may be detrimental for brain development. However, little is known regarding the association between neonatal iron overload and subsequent neurodevelopment during infancy in vulnerable premature infants.

AIMS

To evaluate the association between neonatal iron overload and neurodevelopment in premature infants.

STUDY DESIGN

Prospective cohort study.

SUBJECTS

24-32 weeks gestational age infants who had serum ferritin (SF) measured at 34-35 weeks post-menstrual age (PMA) and did not meet exclusion criteria: SF<76 ng/ml, toxoplasmosis, syphilis, rubella, cytomegalovirus, herpes infections, chromosomal disorders, or craniofacial anomalies were eligible. In addition, infants with sepsis or elevated C-reactive protein within 10 days before their SF measurement were excluded.

OUTCOME MEASURES

Infants were evaluated for neurodevelopmental outcome at 8-12 months of age and were deemed to have neurodevelopmental impairment if they had one or more of the following: mental developmental index<70, abnormal neurological examination, bilateral blindness, bilateral deafness, or required occupational, physical, or speech therapy.

RESULTS

95 infants were studied. 70 had normal iron status (SF 76-400 ng/ml) while 25 were deemed to have iron overload (SF >400 ng/ml) at 34-35 weeks PMA. There was a marginal increase in neurodevelopmental impairment among infants with iron overload compared to infants with normal iron status (64% vs. 41%, p=0.05). However, after controlling for confounders, iron overload was not associated with neurodevelopmental impairment (Adjusted OR 0.71, 95% CI, 0.21-2.5).

CONCLUSION

Modest neonatal iron overload is not associated with neurodevelopmental impairment during infancy in premature infants.

Pre-discharge iron status and its determinants in premature infants

OBJECTIVE

To evaluate pre-discharge iron status and identify its determinants in infants' ≤ 32 weeks gestational age (GA).

METHODS

In a prospective observational study, 24-32 weeks GA infants who did not meet exclusion criteria: congenital viral infections, chromosomal disorders, or cranio-facial anomalies were eligible. Iron status was evaluated by measuring serum ferritin (SF) at 35 weeks post-menstrual age (PMA). Infants with infection or elevated C-reactive protein within 10 days prior to evaluation of iron status were excluded.

RESULTS

Of 131 infants studied, 23% had latent iron deficiency (SF < 76 ng/ml), 58% had normal iron status (75-400 ng/ml), and 19% had iron overload (SF > 400 ng/ml). On bivariate analysis, preeclampsia, GA, birth weight, patent ductus arteriosus, prior erythrocyte transfusion, phlebotomy loss, and chronic lung disease were associated with iron status. On ordered logistic regression, prior erythrocyte transfusion (frequency [OR 1.41, 95% CI:1.2-1.6] or cumulative amount [OR 1.03, 95% CI:1.02-1.04]) or net erythrocyte balance (amount of erythrocyte transfusion minus phlebotomy loss; OR 1.04, 95% CI:1.02-1.05) was significantly associated with iron status. Among infants who received > three erythrocyte transfusions, 50% developed iron overload.

CONCLUSIONS

Iron status at 35 weeks PMA is extremely variable and is predicted by prior erythrocyte transfusions or net erythrocyte balance in premature infants.

Trace elements and antioxidant enzymes in extremely low birthweight infants

Oxygen radicals are believed to contribute to typical diseases of prematurity, such as bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP) and necrotising enterocolitis (NEC). Our aim was to investigate whether these disorders are associated with disturbances in antioxidant enzyme activities and with low trace elements, which are co-factors of antioxidant enzymes. 209 infants with birthweight less than 1000g were enrolled into a European multicentre randomised erythropoietin (rhEPO) trial; 155 developed one or more of the above mentioned diseases. We analysed Zn, Cu, Fe, Se in plasma and red blood cells (RBCs), superoxide dismutase (CuZn-SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) in RBCs on the 3rd and 68th day of life. Zn, Fe, Se in plasma, and Se in RBCs decreased (p<0.01), and Zn in RBC (p<0.001), CuZn-SOD (p<0.01) and CAT increased (p<0.05), whereas GSH-Px remained unchanged. No differences were observed between the rhEPO and control groups. Antioxidant enzyme activities did not correlate with gestational age. In infants with BPD, IVH, ROP, or NEC, CuZn-SOD and CAT (p<0.05) were higher at day 68 than in infants without these diseases. CuZn-SOD and GSH-Px at 3 days and CuZn-SOD at 68 days correlated positively (p<0.05) with the duration of oxygen treatment. In conclusion, in ELBW infants, trace element concentrations decreased over the first 10 weeks of life. Lower trace element concentrations, did not affect the activities of CuZn-SOD, GSH-Px, and CAT. Typical diseases of prematurity were not associated with decreased antioxidant enzyme activities.

Impact of delivery mode and gestational age on haematological parameters in Taiwanese preterm infants

AIM

Reference ranges of haematological parameters in preterm infants are limited. The aim of this study is to determine the reference values of haematological parameters in preterm infants in Taiwan, and to assess the impact of gestational age and mode of delivery on these parameters.

METHOD

Medical records were retrospectively reviewed in preterm infants admitted to National Taiwan University Hospital from January 2001 to December 2004. The inclusion criteria included infants with <37 weeks of gestation who had blood sampling within 24 h of birth. The exclusion criteria included those with maternal history of antepartum haemorrhage, chorioamnionitis, fever, sepsis, preeclampsia and hypertension; and perinatal history of twin-to-twin transfusion syndrome, feto-maternal transfusion, injury and infection.

RESULTS

Of 568 preterm infants with blood cell counts, 337 were available for analysis. There were trends of increase in red blood cell counts, haemoglobin levels and haematocrit values as gestation increased up to 34 weeks. In contrast, a trend of decrease was noted in mean corpuscular volume values. There was an initial trend of decrease in white blood cell counts and then increased after 31 weeks gestation. The platelet counts were essentially unchanged. Infants born by vaginal delivery generally had higher haematological parameters than those born by Caesarean section at different gestational ages except for mean corpuscular volume values.

CONCLUSIONS

We established the reference ranges of haematological parameters in Taiwanese preterm infants. Health-care professionals must be cautious in clinical application of the haematological values because of varying antenatal and perinatal risk factors.

Platelet reference ranges for neonates, defined using data from over 47,000 patients in a multihospital healthcare system

OBJECTIVE

Identifying a platelet count as abnormal (thrombocytopenia or thrombocytosis) can facilitate recognizing various disease states. However, the published reference ranges for platelet counts in neonates may be imprecise, as they were generated from relatively small sample sizes and compiled before modern platelet enumeration methods.

STUDY DESIGN

We derived new neonatal reference ranges for platelet counts and mean platelet volume (MPV) measurements using electronic data accumulated during a recent 6-year period from a multihospital healthcare system.

RESULT

Platelet counts were obtained between the first and the 90th day after birth, from 47,291 neonates delivered at 22 to 42 weeks gestation. The first platelet counts obtained in the first 3 days of life, increased over the range of 22 to 42 weeks gestation. In those born < or =32 weeks gestation, the lower reference range (5th percentile) was 104,200 microl(-1), but it was 123,100 microl(-1) in late-preterm and -term neonates. Advancing postnatal age had a significant effect on platelet counts; during the first 9 weeks, the counts fit a sinusoidal pattern with two peaks; one at 2 to 3 weeks and a second at 6 to 7 weeks. The upper limit of expected counts (95th percentile) during these peaks were as high as 750,000 microl(-1).

CONCLUSION

The figures herein describe reference ranges for platelet counts and MPV determinations of neonates at various gestational ages during their first 90 days. Expected values differ substantially from the 150,000 microl(-1) to 450,000 microl(-1) range previously used to define neonatal thrombocytopenia and thrombocytosis. The new definitions will render the diagnoses of neonatal thrombocytopenia and thrombocytosis less commonly than when the old definitions were used, because the new ranges are wider than 150,000 microl(-1) to 450,000 microl(-1).

Hematological profile of Korean very low birth weight infants

For very low birth weight (VLBW) infants, diagnostic and therapeutic decisions widely depend on hematological values. Although ethnic differences for hematologic parameters have been reported, few studies have been reported for Korean VLBW infants. This study aimed at defining the hematological reference values for medical research and clinical practice. Retrospectively we selected 149 infants confirmed as healthy at birth and had no medical conditions that may have affected the hematological profile. Hematological values obtained within the first 4 h after birth were classified into gestational age and we determined the influence of gender, mode of delivery, sampling site, 1-min and 5-min Apgar scores on these values. Red blood cell (RBC), hemoglobin (Hb) and hematocrit (Hct) values increased, whereas the white blood cell (WBC) and platelets decreased as the gestational age increased. In relation to the mode of delivery and the 5-min Apgar score, WBC, neutrophil, mean corpuscular volume (MCV), RBC, Hb, Hct and the platelets differed selectively. No differences in any hematological values were observed in relation to gender, sampling site, and the 1-min Apgar score. This study should be useful as a guide to the reference range of these hematological values for Korean VLBW infants.

Leukocytosis in very low birth weight neonates: associated clinical factors and neonatal outcomes

OBJECTIVE

Primary objective was to identify clinical factors and outcomes associated with leukocytosis in very low birth weight (VLBW) neonates. Secondary objective was to compare outcomes between infants with early-onset (<or=72 h of age) and late-onset leukocytosis (>72 h).

STUDY DESIGN

A retrospective matched cohort study of VLBW neonates born at <or=30 weeks of gestation identified with a white blood cell count of >or=40,000 was undertaken. Matched infants had no leukocytosis and were of similar gestational age. Data on common neonatal morbidities were collected from charts.

RESULT

Leukocytosis was identified in 96 infants giving an incidence rate of 6.1%. Of all, 94 matched infants without leukocytosis were identified. There were no differences in the demographic features and risk factors between the two groups. The incidence of confirmed infection among infants with leukocytosis was 22%. No differences in common neonatal morbidities and mortality were identified between two groups. Late-onset leukocytosis (>or=72 h of age) was associated with sepsis and necrotizing enterocolitis. No differences in any of the other outcomes between early-onset and late-onset leukocytosis were identified.

CONCLUSION

Leukocytosis, especially late onset, was associated with infection in VLBW infants. Late-onset leukocytosis was also associated with necrotizing enterocolitis indicating that postnatal age at time of leukocytosis should be considered when formulating clinical decisions.

Hematologic Effects of Maternal Antiretroviral Therapy and Transmission Prophylaxis in HIV-1-Exposed Uninfected Newborn Infants

OBJECTIVE

A prospective observational study to investigate hematologic alterations during the first 3 months of life in HIV-exposed uninfected infants subjected to antiretroviral medication before and after birth.

METHODS

Two hundred twenty-one consecutive uninfected infants born to HIV-positive mothers on antiretroviral medication during pregnancy were included. Perinatal transmission prophylaxis comprised zidovudine (ZDV) administered intravenously intrapartum and 10 days after birth. Blood counts and differentials were determined at birth and at 2, 4, 6, and 12 weeks of age, and hematologic toxicity was graded according to pediatric toxicity scales. Data were analyzed according to the kind of prenatal medication (ZDV alone or with another nucleoside reverse transcriptase inhibitor [NRTI] vs. highly active antiretroviral therapy [HAART]).

RESULTS

Median hemoglobin was significantly lower in HAART-exposed newborns from birth (P = 0.004) until day 28. During follow-up, 119 (53.8%) infants had anemia grade 2 or higher on at least 1 occasion; 16 (7.2%) received red blood cell transfusion at 23 (range: 1-56) days of age. Neutropenia grade 2 or higher occurred in 106 (48.0%) infants at least once; 8 infants had staphylococcal infections, and 2 infections were severe. After adjustment for possible confounders (prematurity, birth weight, ethnicity, gender, duration of maternal antiretroviral therapy, maternal Centers for Disease Control and Prevention stage, and maternal illicit drug use), HAART exposure was the only independent risk factor for anemia (odds ratio [OR] = 2.22, 95% confidence interval [CI]: 1.06 to 4.64; P = 0.034) and neutropenia (OR = 2.15, CI: 1.02 to 4.55; P = 0.045).

CONCLUSIONS

Antiretroviral transmission prophylaxis is associated with significant anemia and neutropenia in HIV-uninfected infants during the first 3 months of life. Anemia was more profound in HAART-exposed infants.

Sustained hematological consequences in the first week of neonatal life secondary to placental dysfunction

OBJECTIVE

To evaluate the relationship between umbilical artery end diastolic velocity in growth restricted fetuses and neonatal hematologic parameters.

STUDY DESIGN

Growth restricted fetuses were studied with ultrasound and Doppler evaluations. Neonates were analyzed in two groups based on umbilical artery Doppler status: positive end-diastolic velocities (PEDV) and absent or reversed end-diastolic velocities (AEDV). At birth and throughout the first week of life, groups were compared for anemia and thrombocytopenia; transfusion of red blood cells, platelets, and fresh frozen plasma; and intraventricular hemorrhage (IVH).

RESULTS

Seventy-three neonates met inclusion criteria, 38 with PEDV, 35 with AEDV. Those with AEDV were delivered 3 weeks earlier, were 450 g smaller, had lower cord arterial pH values, and greater cord artery base deficits (p<0.05, respectively). AEDV neonates were twice as likely to be anemic and thrombocytopenic at birth and remain so during the first week, requiring more red blood cell and platelet transfusions. There was no difference in occurrence of severe IVH between groups.

CONCLUSION

Hematological alterations associated with intrauterine growth restriction appear to continue into the first week of neonatal life. These are proportional to the degree of placental dysfunction and are predicted by fetal Doppler status.

SUMMARY

Abnormal development of the placental vascular tree is the primary step in a cascade of fetal compromises leading to intrauterine growth restriction (IUGR). Doppler ultrasound evaluation of fetal and placental blood flows provides a non-invasive assessment of the fetal condition which reflects the impact of placental vascular abnormalities. The degree of placental dysfunction determines the severity of fetal disease, which can affect many fetal organ systems. In addition to disturbances in placental respiratory function, abnormal umbilical artery Doppler status is also indicative of hematologic abnormalities during fetal life and at birth. Neonates who had more severe placental dysfunction, as depicted by absent umbilical artery end diastolic velocity, were more likely to be anemic and thrombocytopenic at birth and remain so during the first week of life, and required more transfusions than those with positive end diastolic velocities. The severity of hematologic alterations during the first week of life in growth restricted neonates was proportional to and predicted by the antenatal umbilical artery end diastolic velocity Doppler status.

Late-onset neutropenia in very low birthweight infants

AIM

To evaluate the incidence and duration of late-onset neutropenia (defined as an absolute neutrophil count (ANC) <1500 mm(-3) at a postnatal age of >3 wk) in a population of infants with birthweight <2000 g, and to determine whether copper deficiency, a possible cause of both anemia and neutropenia, may be associated with this complication.

METHODS

Complete blood cell count and differential were assessed in 247 low (LBW) and very low birthweight (VLBW) infants who were discharged after 3 wk of life. In neutropenic infants plasma copper and ceruloplasmin levels were also measured.

RESULTS

Late-onset neutropenia was detected in 11 out of 147 VLBW infants (7.5%) and in 7 out of 127 LBW infants (5.5%). A neutrophil count of <1000 mm(-3) was observed in 14 infants (5.1%). A significantly lower gestational age was found in neutropenic infants compared with non-neutropenic infants. In neutropenic infants ANCs were significantly correlated with hemoglobin and hematocrit. In addition, a significant negative correlation was found between neutrophil and reticulocyte counts. Plasma copper concentration was significantly correlated with birthweight. Oral copper sulfate was administered to infants with plasma copper concentration <50 microg dl(-1), and did not seem to affect ANC, hemoglobin, hematocrit or reticulocyte counts.

CONCLUSION

Late-onset neutropenia appears to be a benign condition that is not associated with any particular complication and does not require specific treatment. Reference ranges after the early neonatal period and during the first few months of life in LBW and VLBW infants should probably be set at lower values.