ABSTRACT
The purpose of this study was to identify maternal and neonatal characteristics affecting
marked neonatal neutropenia in pregnancies complicated by hypertension. A single institution
retrospective chart review over 2 years of singleton and multifetal pregnancies with
hypertensive disorders meeting American College of Obstetricians and Gynecologists
criteria was performed. Neutropenia and sepsis occurring within the first 16 days
of life (DOL) were studied. Neutropenia was defined as an absolute neutrophil count
of <1500/μL and sepsis as any positive blood, cerebrospinal fluid, or urine culture.
The study group contained neonates with neutropenia. From all other hypertensive pregnancies,
a presumed nonneutropenic control group was randomly generated with a 4:1 ratio; these
neonates may or may not have had a complete blood count (CBC) performed because they
were clinically stable. Multiple gestations were separately analyzed and compared
with hypertensive multifetal neonates with confirmed CBCs showing no neutropenia.
Chi-square, Mann-Whitney U, and regression analyses were performed. Five hundred forty-three hypertensive pregnancies
representing 633 births, 173 (27.3%) of which were from multiple gestations, were
studied. There were 32 (5.9%) cases of neutropenia, with 22 (68.8%) from multiple
gestations. Of premature multiple gestations, 45.2% born between 24 and 34 weeks'
gestation developed neutropenia. The median time to diagnosis of neutropenia was 1.2
hours with 80.6% detected on the first DOL. Resolution of neutropenia occurred within
7 days in 84.4% of surviving neonates. Univariate analysis showed significant associations
of neutropenia with gestational age at delivery, multiple gestations, birth weight,
severe preeclampsia, and development of neonatal sepsis. When multiple gestations
were analyzed, linear regression showed only sepsis to be significantly associated
with neutropenia (p = 0.027). Hypertensive disorders of pregnancy and premature delivery are common in
multiple gestations and are associated with neutropenia (12.7% versus 2.2% neutropenia
in singletons (p < 0.001). Furthermore, multiple gestations with neutropenia had a higher incidence
of sepsis than singletons with neutropenia.
KEYWORDS
Pre-eclampsia - multifetal pregnancy - hypertension - neonate - sepsis
REFERENCES
- 1
Diagnosis and management of preeclampsia and eclampsia. ACOG Practice Bulletin No.
33. American College of Obstetricians and Gynecologists.
Obstet Gynecol.
2002;
99
159-167
- 2
Walker M C, Murphy K E, Pan S, Yang Q, Wen S W.
Adverse maternal outcomes in multifetal pregnancies.
BJOG.
2004;
111
1294-1296
- 3
Conde-Agudelo A, Belizan J M, Lindmark G.
Maternal morbidity and mortality associated with multiple gestations.
Obstet Gynecol.
2000;
95(6 Pt 1)
899-904
- 4
Mouzinho A, Rosenfeld C R, Sanchez P J, Risser R.
Revised reference ranges for circulating neurophils in very-low-birth–weight neonates.
Pediatrics.
1994;
94
76-82
- 5
Juul S E, Haynes J W, McPherson R J.
Evaluation of neutropenia and neutrophilia in hospitalized preterm infants.
J Perinatol.
2004;
24
150-157
- 6
Fraser S H, Tudehope D I.
Neonatal neutropenia and thrombocytopenia following maternal hypertension.
J Paediatr Child Health..
1996;
32
31-34
- 7
Koenig J M, Christensen R D.
Incidence, neutrophil kinetics, and natural history of neonatal neutropenia associated
with maternal hypertension.
N Engl J Med.
1989;
321
557-562
- 8
Manroe B L, Weinberg A G, Rosenfeld C R, Browne R.
The neonatal blood count in health and disease. I. Reference values for neutrophilic
cells.
J Pediatr.
1979;
95
89-98
- 9
Engle W D, Rosenfeld C R.
Neutropenia in high-risk neonates.
J Pediatr.
1984;
105
982-986
- 10
Mouzhino A, Rosenfeld C R, Sanchez P J, Risser R.
Effect of maternal hypertension and risk of nosocomial infection.
Pediatrics.
1992;
90
430-435
- 11
Cadnapaphornchai M, Faix R G.
Increased nosocomial infection in neutropenic low birth weight (2000 g or less) infants
of hypertensive mothers.
J Pediatr.
1992;
121
956-961
- 12
Brazy J E, Grimm J K, Little V A.
Neonatal manifestations of severe maternal hypertension occurring before the thirty-sixth
week of pregnancy.
J Pediatr.
1982;
100
265-271
- 13
Doron M, Maklouf R A, Katz V L, Lawson E E, Stiles A D.
Increased incidence of sepsis at birth in neutropenic infants of mothers with preeclampsia.
J Pediatr.
1994;
125
452-458
- 14
Schmutz N, Henry E, Jopling J, Christensen R D.
Expected ranges for blood neutrophil concentrations of neonates the Manroe and Mouzinho
charts revisted.
J Perinatol.
2008;
28
275-281
- 15
Chronic hypertension in pregnancy. ACOG Practice Bulletin No. 29. American College
of Obstetricians and Gynecologists.
Obstet Gynecol.
2001;
98(suppl)
177-185
- 16
Alexander G R, Himes J H, Kaufman R B, Mor J, Kogan M.
A United States national reference for fetal growth.
Obstet Gynecol.
1996;
87
163-168
- 17
Day M C, Barton J R, O'Brien J M, Istwan N B, Sibai B M.
The effect of fetal number on the development of hypertensive conditions of pregnancy.
Obstet Gynecol.
2005;
106(5 Pt 1)
927-931
- 18
Christensen R D, Henry E, Wiedemeier S E, Stoddard R A, Lambert D K.
Low blood neutrophil concentrations among extremely low birth weight neonates: data
from a multihospital healthcare system.
J Perinatol.
2006;
26
682-687
- 19
Kuntz T B, Christensen R D, Stegner R, Duff P, Koenig J M.
Fas and Fas ligand expression in maternal blood and umbilical cord blood in preeclampsia.
Pediatr Res.
2001;
50
743-749
- 20
Englert Y, Imbert M C, Van Rosendael E, Belaisch J, Segal L, Feichtinger W, Wilkin P,
Frydman R, Leroy F.
Morphological anomalies in the placentae of IVF pregnancies: preliminary report of
a multicentric study.
Hum Reprod.
1987;
2
155-157
James B BusselM.D.
Weill Cornell Medical College, 525 East 68th Street
P695, New York, NY 10065
Email: jbussel@med.cornell.edu