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Neonatal nucleated red blood cell counts in small-for-gestational age fetuses with abnormal umbilical artery Doppler studies.
Am J Obstet Gynecol 1997; 177(5):1079-84AJ

Abstract

OBJECTIVE

The presence of elevated nucleated red blood cell counts in neonatal blood has been associated with fetal hypoxia. We sought to determine whether small-for-gestational-age fetuses with abnormal umbilical artery Doppler velocity waveforms have elevated nucleated red blood cell counts.

STUDY DESIGN

Hospital charts of neonates with the discharge diagnosis of small for gestational age (birth weight < 10th percentile) who were delivered between October 1988 and June 1995 were reviewed for antepartum testing, delivery conditions, and neonatal outcome. We studied fetuses who had an umbilical artery systolic/diastolic ratio within 3 days of delivery and a complete blood cell count on the first day of life. Multiple gestations, anomalous fetuses, and infants of diabetic mothers were excluded. Statistical analysis included the Student t test, chi 2 analysis, analysis of variance, and simple and stepwise regression.

RESULTS

Fifty-two infants met the inclusion criteria. Those with absent or reversed end-diastolic velocity (n = 19) had significantly greater nucleated red blood cell counts than did those with end-diastolic velocity present (n = 33) (nucleated red blood cells/100 nucleated cells +/- SD: 135.5 +/- 138 vs 17.4 +/- 23.7, p < 0.0001). These infants exhibited significantly longer time intervals for clearance of nucleated red blood cells from their circulation (p < 0.0001). They also had lower birth weights (p < 0.05), lower initial platelet count (p = 0.0006), lower arterial cord blood pH (p < 0.05), higher cord blood base deficit (p < 0.05), and an increased likelihood of cesarean section for "fetal distress" (p < 0.05). Multivariate analysis demonstrated that absent or reversed end-diastolic velocity (p < 0.0001) and low birth weight (p < 0.0001) contributed to the elevation of the nucleated red blood cell count, whereas gestational age at delivery was not a significant contributor.

CONCLUSION

We observed significantly greater nucleated red blood cell counts and lower platelet counts in small-for-gestational-age fetuses with abnormal umbilical artery Doppler studies. This may suggest that antenatal thrombotic events lead to an increased placental impedance. Fetal response to this chronic condition may result in an increased nucleated red blood cell count.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY 10461-2373, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9396897

Citation

Bernstein, P S., et al. "Neonatal Nucleated Red Blood Cell Counts in Small-for-gestational Age Fetuses With Abnormal Umbilical Artery Doppler Studies." American Journal of Obstetrics and Gynecology, vol. 177, no. 5, 1997, pp. 1079-84.
Bernstein PS, Minior VK, Divon MY. Neonatal nucleated red blood cell counts in small-for-gestational age fetuses with abnormal umbilical artery Doppler studies. Am J Obstet Gynecol. 1997;177(5):1079-84.
Bernstein, P. S., Minior, V. K., & Divon, M. Y. (1997). Neonatal nucleated red blood cell counts in small-for-gestational age fetuses with abnormal umbilical artery Doppler studies. American Journal of Obstetrics and Gynecology, 177(5), pp. 1079-84.
Bernstein PS, Minior VK, Divon MY. Neonatal Nucleated Red Blood Cell Counts in Small-for-gestational Age Fetuses With Abnormal Umbilical Artery Doppler Studies. Am J Obstet Gynecol. 1997;177(5):1079-84. PubMed PMID: 9396897.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neonatal nucleated red blood cell counts in small-for-gestational age fetuses with abnormal umbilical artery Doppler studies. AU - Bernstein,P S, AU - Minior,V K, AU - Divon,M Y, PY - 1997/12/16/pubmed PY - 1997/12/16/medline PY - 1997/12/16/entrez SP - 1079 EP - 84 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 177 IS - 5 N2 - OBJECTIVE: The presence of elevated nucleated red blood cell counts in neonatal blood has been associated with fetal hypoxia. We sought to determine whether small-for-gestational-age fetuses with abnormal umbilical artery Doppler velocity waveforms have elevated nucleated red blood cell counts. STUDY DESIGN: Hospital charts of neonates with the discharge diagnosis of small for gestational age (birth weight < 10th percentile) who were delivered between October 1988 and June 1995 were reviewed for antepartum testing, delivery conditions, and neonatal outcome. We studied fetuses who had an umbilical artery systolic/diastolic ratio within 3 days of delivery and a complete blood cell count on the first day of life. Multiple gestations, anomalous fetuses, and infants of diabetic mothers were excluded. Statistical analysis included the Student t test, chi 2 analysis, analysis of variance, and simple and stepwise regression. RESULTS: Fifty-two infants met the inclusion criteria. Those with absent or reversed end-diastolic velocity (n = 19) had significantly greater nucleated red blood cell counts than did those with end-diastolic velocity present (n = 33) (nucleated red blood cells/100 nucleated cells +/- SD: 135.5 +/- 138 vs 17.4 +/- 23.7, p < 0.0001). These infants exhibited significantly longer time intervals for clearance of nucleated red blood cells from their circulation (p < 0.0001). They also had lower birth weights (p < 0.05), lower initial platelet count (p = 0.0006), lower arterial cord blood pH (p < 0.05), higher cord blood base deficit (p < 0.05), and an increased likelihood of cesarean section for "fetal distress" (p < 0.05). Multivariate analysis demonstrated that absent or reversed end-diastolic velocity (p < 0.0001) and low birth weight (p < 0.0001) contributed to the elevation of the nucleated red blood cell count, whereas gestational age at delivery was not a significant contributor. CONCLUSION: We observed significantly greater nucleated red blood cell counts and lower platelet counts in small-for-gestational-age fetuses with abnormal umbilical artery Doppler studies. This may suggest that antenatal thrombotic events lead to an increased placental impedance. Fetal response to this chronic condition may result in an increased nucleated red blood cell count. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/9396897/Neonatal_nucleated_red_blood_cell_counts_in_small_for_gestational_age_fetuses_with_abnormal_umbilical_artery_Doppler_studies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(97)70018-8 DB - PRIME DP - Unbound Medicine ER -