Cm. Salafia et al., PATTERNS OF CHANGE IN EARLY NEONATAL NUCLEATED ERYTHROCYTE COUNTS IN PRETERM DELIVERIES, Journal of the Society for Gynecologic Investigation, 4(4), 1997, pp. 178-182
OBJECTIVE: To examine whether changes in nucleated erythrocyte (nRBC)
counts in the early neonatal period can distinguish between causes of
nRBC release. METHODS: From a data set of 465 nonanomalous singleton l
ive births delivered at 22-32 weeks, excluding maternal diabetes melli
tus, Rh isoimmunization, and chronic hypertension, 125 cases had a com
plete blood count with an nRBC count within 3 hours of life and at lea
st one other value obtained within 48 hours of the first. The change i
n nRBC count per deciliter was calculated (Delta nRBC) and was correla
ted with antenatal fetal assessment, neonatal outcome variables, and p
lacental histopathology in five categories: 1) histologic acute intrau
terine inflammation, 2) uteroplacental vascular lesions, 3) intraplace
ntal vaso-occlusive lesions, 4) chronic inflammation, and 5) coagulati
on-related lesions. RESULTS: There were 92 cases (74%) of premature ru
pture of membranes (PROM) and preterm labor/intact membranes (PTL) and
33 cases (26%) of preclampsia. In PROM/PTL, multivariate analyses dem
onstrated that a higher uteroplacental vascular lesion score was relat
ed to more stable nRBC counts (P = .009), whereas a higher nonmyeloid
count in the initial neonatal white blood cell count was related to a
more rapid decrease in Delta nRBC (combined r = 0.54, P < .0001). No f
eatures were related to Delta nRBC in preeclampsia. CONCLUSION: In PRO
M/PTL, but not in preeclampsia, patterns of change in the nRBC count i
n the early newborn period vary with uteroplacental vascular lesions a
nd acute inflammation. This may reflect differences in the mediators o
f nRBC release (erythropoietin versus cytokines) and in disease acuity
. Copyright (C) 1997 by the Society for Gynecologic Investigation.