Neonatal nucleated red blood cells and the prediction of cerebral white matter injury in preterm infants

Anadir M. Silva, Randi N. Smith, Christoph U. Lehmann, Elizabeth A. Johnson, Cynthia J. Holcroft, Ernest M. Graham

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

OBJECTIVE: To estimate whether neonates with cerebral white matter injury have significant elevations in nucleated red blood cell counts and to estimate their predictive ability in identifying injury. METHODS: This case-control study identified 176 infants born at 23-34 weeks of gestation between November 1994 and October 2004 at a single university hospital and with cerebral white matter injury characterized by periventricular leukomalacia (PVL) or ventriculomegaly due to white matter atrophy. A control was matched to each case using the subsequent delivery within 7 days of that gestational age without brain injury. RESULTS: The gestational age at birth was 27 weeks for both groups, but the cases had a significantly lower birth weight (mean ± standard deviation: 958 ± 306 g compared with 1,038 ± 381 g, P = .001). There was no difference in cesarean delivery (48% cases compared with 44% controls, P = .59). The cases had a significant increase in nucleated red blood cells per 100 white blood cells (WBC) (median, 5th percentile and 95th percentile: 22, 3 and 374 cases compared with 14, 1 and 312 controls; P = .02). Markers of chronic hypoxia, such as intrauterine growth restriction and oligohydramnios, and markers of acute hypoxia, such as an umbilical arterial pH less than 7.0 or base excess less than -12 mM, were both associated with significantly elevated neonatal nucleated red blood cell counts. A neonatal nucleated red blood cell count of 18 per 100 WBCs had a sensitivity of 56.9%, specificity of 57.9%, positive predictive value of 57.9%, and negative predictive value of 56.9% in predicting the development of cerebral white matter injury in this matched case-control sample. CONCLUSION: Preterm neonates with cerebral white matter injury have significant increases in nucleated red blood cell counts. Both acute and chronic hypoxia-ischemia can increase these counts, which limits their usefulness in timing injury. The predictive value of nucleated red blood cell counts at birth in identifying injury is poor.

Original languageEnglish (US)
Pages (from-to)550-556
Number of pages7
JournalObstetrics and gynecology
Volume107
Issue number3
DOIs
StatePublished - Mar 1 2006
Externally publishedYes

Fingerprint

Premature Infants
Erythrocyte Count
Erythrocytes
Wounds and Injuries
Gestational Age
Parturition
Periventricular Leukomalacia
Oligohydramnios
Umbilicus
White Matter
Birth Weight
Brain Injuries
Atrophy
Case-Control Studies
Leukocytes
Ischemia
Newborn Infant
Sensitivity and Specificity
Pregnancy
Growth

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Neonatal nucleated red blood cells and the prediction of cerebral white matter injury in preterm infants. / Silva, Anadir M.; Smith, Randi N.; Lehmann, Christoph U.; Johnson, Elizabeth A.; Holcroft, Cynthia J.; Graham, Ernest M.

In: Obstetrics and gynecology, Vol. 107, No. 3, 01.03.2006, p. 550-556.

Research output: Contribution to journalArticle

Silva, Anadir M. ; Smith, Randi N. ; Lehmann, Christoph U. ; Johnson, Elizabeth A. ; Holcroft, Cynthia J. ; Graham, Ernest M. / Neonatal nucleated red blood cells and the prediction of cerebral white matter injury in preterm infants. In: Obstetrics and gynecology. 2006 ; Vol. 107, No. 3. pp. 550-556.
@article{80bf7a2c9ffa4067836654588930a7e8,
title = "Neonatal nucleated red blood cells and the prediction of cerebral white matter injury in preterm infants",
abstract = "OBJECTIVE: To estimate whether neonates with cerebral white matter injury have significant elevations in nucleated red blood cell counts and to estimate their predictive ability in identifying injury. METHODS: This case-control study identified 176 infants born at 23-34 weeks of gestation between November 1994 and October 2004 at a single university hospital and with cerebral white matter injury characterized by periventricular leukomalacia (PVL) or ventriculomegaly due to white matter atrophy. A control was matched to each case using the subsequent delivery within 7 days of that gestational age without brain injury. RESULTS: The gestational age at birth was 27 weeks for both groups, but the cases had a significantly lower birth weight (mean ± standard deviation: 958 ± 306 g compared with 1,038 ± 381 g, P = .001). There was no difference in cesarean delivery (48{\%} cases compared with 44{\%} controls, P = .59). The cases had a significant increase in nucleated red blood cells per 100 white blood cells (WBC) (median, 5th percentile and 95th percentile: 22, 3 and 374 cases compared with 14, 1 and 312 controls; P = .02). Markers of chronic hypoxia, such as intrauterine growth restriction and oligohydramnios, and markers of acute hypoxia, such as an umbilical arterial pH less than 7.0 or base excess less than -12 mM, were both associated with significantly elevated neonatal nucleated red blood cell counts. A neonatal nucleated red blood cell count of 18 per 100 WBCs had a sensitivity of 56.9{\%}, specificity of 57.9{\%}, positive predictive value of 57.9{\%}, and negative predictive value of 56.9{\%} in predicting the development of cerebral white matter injury in this matched case-control sample. CONCLUSION: Preterm neonates with cerebral white matter injury have significant increases in nucleated red blood cell counts. Both acute and chronic hypoxia-ischemia can increase these counts, which limits their usefulness in timing injury. The predictive value of nucleated red blood cell counts at birth in identifying injury is poor.",
author = "Silva, {Anadir M.} and Smith, {Randi N.} and Lehmann, {Christoph U.} and Johnson, {Elizabeth A.} and Holcroft, {Cynthia J.} and Graham, {Ernest M.}",
year = "2006",
month = "3",
day = "1",
doi = "10.1016/j.jfoodeng.2005.06.068",
language = "English (US)",
volume = "107",
pages = "550--556",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Neonatal nucleated red blood cells and the prediction of cerebral white matter injury in preterm infants

AU - Silva, Anadir M.

AU - Smith, Randi N.

AU - Lehmann, Christoph U.

AU - Johnson, Elizabeth A.

AU - Holcroft, Cynthia J.

AU - Graham, Ernest M.

PY - 2006/3/1

Y1 - 2006/3/1

N2 - OBJECTIVE: To estimate whether neonates with cerebral white matter injury have significant elevations in nucleated red blood cell counts and to estimate their predictive ability in identifying injury. METHODS: This case-control study identified 176 infants born at 23-34 weeks of gestation between November 1994 and October 2004 at a single university hospital and with cerebral white matter injury characterized by periventricular leukomalacia (PVL) or ventriculomegaly due to white matter atrophy. A control was matched to each case using the subsequent delivery within 7 days of that gestational age without brain injury. RESULTS: The gestational age at birth was 27 weeks for both groups, but the cases had a significantly lower birth weight (mean ± standard deviation: 958 ± 306 g compared with 1,038 ± 381 g, P = .001). There was no difference in cesarean delivery (48% cases compared with 44% controls, P = .59). The cases had a significant increase in nucleated red blood cells per 100 white blood cells (WBC) (median, 5th percentile and 95th percentile: 22, 3 and 374 cases compared with 14, 1 and 312 controls; P = .02). Markers of chronic hypoxia, such as intrauterine growth restriction and oligohydramnios, and markers of acute hypoxia, such as an umbilical arterial pH less than 7.0 or base excess less than -12 mM, were both associated with significantly elevated neonatal nucleated red blood cell counts. A neonatal nucleated red blood cell count of 18 per 100 WBCs had a sensitivity of 56.9%, specificity of 57.9%, positive predictive value of 57.9%, and negative predictive value of 56.9% in predicting the development of cerebral white matter injury in this matched case-control sample. CONCLUSION: Preterm neonates with cerebral white matter injury have significant increases in nucleated red blood cell counts. Both acute and chronic hypoxia-ischemia can increase these counts, which limits their usefulness in timing injury. The predictive value of nucleated red blood cell counts at birth in identifying injury is poor.

AB - OBJECTIVE: To estimate whether neonates with cerebral white matter injury have significant elevations in nucleated red blood cell counts and to estimate their predictive ability in identifying injury. METHODS: This case-control study identified 176 infants born at 23-34 weeks of gestation between November 1994 and October 2004 at a single university hospital and with cerebral white matter injury characterized by periventricular leukomalacia (PVL) or ventriculomegaly due to white matter atrophy. A control was matched to each case using the subsequent delivery within 7 days of that gestational age without brain injury. RESULTS: The gestational age at birth was 27 weeks for both groups, but the cases had a significantly lower birth weight (mean ± standard deviation: 958 ± 306 g compared with 1,038 ± 381 g, P = .001). There was no difference in cesarean delivery (48% cases compared with 44% controls, P = .59). The cases had a significant increase in nucleated red blood cells per 100 white blood cells (WBC) (median, 5th percentile and 95th percentile: 22, 3 and 374 cases compared with 14, 1 and 312 controls; P = .02). Markers of chronic hypoxia, such as intrauterine growth restriction and oligohydramnios, and markers of acute hypoxia, such as an umbilical arterial pH less than 7.0 or base excess less than -12 mM, were both associated with significantly elevated neonatal nucleated red blood cell counts. A neonatal nucleated red blood cell count of 18 per 100 WBCs had a sensitivity of 56.9%, specificity of 57.9%, positive predictive value of 57.9%, and negative predictive value of 56.9% in predicting the development of cerebral white matter injury in this matched case-control sample. CONCLUSION: Preterm neonates with cerebral white matter injury have significant increases in nucleated red blood cell counts. Both acute and chronic hypoxia-ischemia can increase these counts, which limits their usefulness in timing injury. The predictive value of nucleated red blood cell counts at birth in identifying injury is poor.

UR - http://www.scopus.com/inward/record.url?scp=33646780591&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646780591&partnerID=8YFLogxK

U2 - 10.1016/j.jfoodeng.2005.06.068

DO - 10.1016/j.jfoodeng.2005.06.068

M3 - Article

C2 - 16507923

AN - SCOPUS:33646780591

VL - 107

SP - 550

EP - 556

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 3

ER -