Am J Perinatol 2010; 27(10): 819-824
DOI: 10.1055/s-0030-1254547
© Thieme Medical Publishers

Intrauterine Growth Retardation in Preterm Infants ≤32 Weeks of Gestation is Associated with Low White Blood Cell Counts

Johannes Wirbelauer1 , Wolfgang Thomas1 , Lorenz Rieger2 , Christian P. Speer1
  • 1University Children's Hospital, University of Wuerzburg, Wuerzburg, Germany
  • 2Department of Obstetrics and Gynecology, University of Wuerzburg, Wuerzburg, Germany
Further Information

Publication History

Publication Date:
17 May 2010 (online)

ABSTRACT

It is unclear if very immature preterm infants who are born small for gestational age (SGA) have similar leukocyte counts as infants who are born appropriate for gestational age (AGA). Our study included 49 preterm infants with a gestational age ≤32 weeks and without exposure to chorioamnionitis and funisitis. Blood cells were counted in the first 2 hours of life. Eighteen SGA preterm infants were compared with 31 AGA preterm infants. Gestational age, sex, rate of caesarean section, and prenatal administration of corticosteroids did not differ between the groups. Median birth weight was 583 g in the SGA group versus 1100 g in the AGA group. Infants in the SGA group had significantly lower counts of leukocytes, total neutrophils, immature neutrophils, lymphocytes, and monocytes. These findings were not affected by maternal preeclampsia. No significant difference for nucleated red blood cell counts was found. Prenatal growth retardation is an independent factor for lower counts of different leukocytes in very immature preterm infants. It is not clear if these low leukocyte counts are associated with a higher risk of neonatal infections or if lower numbers of inflammatory cells protect the lung and brain of very immature SGA infants by reducing inflammatory events postnatally.

REFERENCES

  • 1 Zaw W, Gagnon R, da Silva O. The risks of adverse neonatal outcome among preterm small for gestational age infants according to neonatal versus fetal growth standards.  Pediatrics. 2003;  111(6 Pt 1) 1273-1277
  • 2 McCowan L, Horgan R P. Risk factors for small for gestational age infants.  Best Pract Res Clin Obstet Gynaecol. 2009;  23 779-793
  • 3 Reiss I, Landmann E, Heckmann M, Misselwitz B, Gortner L. Increased risk of bronchopulmonary dysplasia and increased mortality in very preterm infants being small for gestational age.  Arch Gynecol Obstet. 2003;  269 40-44
  • 4 Lal M K, Manktelow B N, Draper E S, Field D J. Population-Based Study . Chronic lung disease of prematurity and intrauterine growth retardation: a population-based study.  Pediatrics. 2003;  111 483-487
  • 5 Gortner L, Wauer R R, Stock G J et al.. Neonatal outcome in small for gestational age infants: do they really better?.  J Perinat Med. 1999;  27 484-489
  • 6 Karagianni P, Kyriakidou M, Mitsiakos G et al.. Neurological outcome in preterm small for gestational age infants compared to appropriate for gestational age preterm at the age of 18 months: a prospective study.  J Child Neurol. 2010;  25 165-170
  • 7 Urlichs F, Speer C P. Neutrophil function in preterm and term infants.  NeoReviews. 2004;  5 417-430
  • 8 Doron M W, Makhlouf 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
  • 9 Christensen R D, Henry E, Wiedmeier S E, Stoddard R A, Lambert D K. Low blood neutrophil concentrations among extremely low birth weight neonates: data from a multihospital health-care system.  J Perinatol. 2006;  26 682-687
  • 10 Edmondson N, Bocking A, Machin G, Rizek R, Watson C, Keating S. The prevalence of chronic deciduitis in cases of preterm labor without clinical chorioamnionitis.  Pediatr Dev Pathol. 2009;  12 16-21
  • 11 Voigt M, Schneider K T, Jährig K. Analysis of a 1992 birth sample in Germany. 1: New percentile values of the body weight of newborn infants.  Geburtshilfe Frauenheilkd. 1996;  56 550-558
  • 12 Brown M A, Hague W M, Higgins J Austalasian Society of the Study of Hypertension in Pregnancy et al. The detection, investigation and management of hypertension in pregnancy: full consensus statement.  Aust N Z J Obstet Gynaecol. 2000;  40 139-155
  • 13 Ment L R, Bada H S, Barnes P et al.. Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.  Neurology. 2002;  58 1726-1738
  • 14 Sweet D, Bevilacqua G, Carnielli V et al.. European consensus guidelines on the management of neonatal respiratory distress syndrome.  J Perinat Med. 2007;  35 175-186
  • 15 Jobe A H, Bancalari E. Bronchopulmonary dysplasia.  Am J Respir Crit Care Med. 2001;  163 1723-1729
  • 16 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
  • 17 Carr R, Huizinga T W. Low soluble FcRIII receptor demonstrates reduced neutrophil reserves in preterm neonates.  Arch Dis Child Fetal Neonatal Ed. 2000;  83 F160
  • 18 Gessler P, Neu S, Nebe T, Speer C P. Granulocyte colony-stimulating factor receptor expression on neutrophils of term and preterm neonates with and without signs of infection.  Eur J Pediatr. 1999;  158 497-500
  • 19 Gessler P, Kirchmann N, Kientsch-Engel R, Haas N, Lasch P, Kachel W. Serum concentrations of granulocyte colony-stimulating factor in healthy term and preterm neonates and in those with various diseases including bacterial infections.  Blood. 1993;  82 3177-3182
  • 20 Cairo M S, Plunkett J M, Nguyen A, van de Ven C. Effect of stem cell factor with and without granulocyte colony-stimulating factor on neonatal hematopoiesis: in vivo induction of newborn myelopoiesis and reduction of mortality during experimental group B streptococcal sepsis.  Blood. 1992;  80 96-101
  • 21 Palta M, Sadek-Badawi M, Carlton D P. Association of BPD and IVH with early neutrophil and white counts in VLBW neonates with gestational age <32 weeks.  J Perinatol. 2008;  28 604-610
  • 22 Manzoni P, Farina D, Monetti C et al.. Early-onset neutropenia is a risk factor for Candida colonization in very low-birth-weight neonates.  Diagn Microbiol Infect Dis. 2007;  57 77-83
  • 23 Teng R J, Wu T J, Garrison R D, Sharma R, Hudak M L. Early neutropenia is not associated with an increased rate of nosocomial infection in very low-birth-weight infants.  J Perinatol. 2009;  29 219-224
  • 24 Carr R, Brocklehurst P, Doré C J, Modi N. Granulocyte-macrophage colony stimulating factor administered as prophylaxis for reduction of sepsis in extremely preterm, small for gestational age neonates (the PROGRAMS trial): a single-blind, multicentre, randomised controlled trial.  Lancet. 2009;  373 226-233
  • 25 Speer C P. Chorioamnionitis, postnatal factors and proinflammatory response in the pathogenetic sequence of bronchopulmonary dysplasia.  Neonatology. 2009;  95 353-361
  • 26 Dammann O, Leviton A. Maternal intrauterine infection, cytokines, and brain damage in the preterm newborn.  Pediatr Res. 1997;  42 1-8
  • 27 Morag I, Dunn M, Nayot D, Shah P S. Leukocytosis in very low birth weight neonates: associated clinical factors and neonatal outcomes.  J Perinatol. 2008;  28 680-684
  • 28 Baschat A A, Gungor S, Kush M L et al.. Nucleated red blood cell counts in the first week of life: a critical appraisal of relationships with perinatal outcome in preterm growth-restricted neonates.  Am J Obstet Gynecol. 2007;  197 286.e1-e8
  • 29 Jobe A H, Hillman N, Polglase G, Kramer B W, Kallapur S, Pillow J. Injury and inflammation from resuscitation of the preterm infant.  Neonatology. 2008;  94 190-196

Dr. Johannes Wirbelauer

University Children's Hospital, University of Wuerzburg, Josef-Schneider-Straße 2

97080 Wuerzburg, Germany

Email: wirbelauer_j@klinik.uni-wuerzburg.de