Increased nucleated red blood cell counts in small for gestational age infants with very low birth weight.

There are few reported studies of water balance and electrolyte abnormalities in extremely low birthweight (ELBW) infants weighing < 1000 g nursed in high humidity. We retrospectively analyzed water balance, electrolyte and acid-base balance in 100 ELBW infants, of whom 72 were appropriate for gestational age (AGA) and 28 were small for gestational age (SGA). They were cared for in closed incubators at almost full ambient humidity. Fluid intake was restricted to 50-60 mL/kg on the first day of life and was adjusted to maintain normal serum Na concentration. Weight loss in AGA and SGA infants was 21.6 and 16.7%, respectively, and was associated with large urine volume rather than insensible water loss. The incidence of hypernatremia (> 150 mEq/L) and hyponatremia (< 130 mEq/L) was 8.0 and 33.3%, respectively. The incidence of hyperkalemia in AGA infants was 37.0%, and 14.8% in the SGA group. However, hyperkalemia requiring treatment was rare. The incidence of late metabolic acidosis in AGA and SGA infants was 84.6 and 37.5%, respectively (P < 0.01). The difference in water balance and electrolyte abnormalities in AGA and SGA infants needs to be taken into account in managing ELBW infants.

The aim of this study was to evaluate the influence of pre-eclampsia on the cord and maternal nucleated red blood cell (NRBC) count. Immediately after delivery, 1 mL of maternal venous blood and 1 mL of cord blood from 50 pre-eclamptic and 150 healthy pregnant women were collected separately in tubes containing 1.5 mg ethylene diamine tetra-acetic acid. Blood smears were prepared and stained using the Giemsa method. The number of NRBC per 100 leukocytes in maternal and cord blood was counted and compared between the two groups using SPSS software package for Windows. Any correlation of the NRBC count in maternal and umbilical cord blood was also evaluated. P-values < 0.05 were considered significant. The mean (+/-SD) NRBC per 100 white blood cell (WBC) level in cord blood of newborns in the pre-eclamptic group (18.2 +/- 31.8, range 0-142) was significantly greater than in the control group (6.2 +/- 8.1, range 0-36). Low birth weight and intrauterine growth restriction showed a statistically significant relationship with abnormal NRBC count in pre-eclamptic patients. A significant correlation was found between the maternal and cord blood NRBC count in the pre-eclamptic group. Fetal response to utero-placental insufficiency in pre-eclampsia leads to elevated NRBC in the cord blood, particularly in the presence of low birth weight and intrauterine growth restriction. The positive correlation between maternal and cord blood NRBC counts in pre-eclamptic patients indicates that maybe the hypoperfused placenta plays a role in the correlated alteration of the maternal and fetal NRBC count.

Increased Nucleated RBCs in Cord Blood: Not an Exclusion Criterion but a Quality Indicator for Hematopoietic Progenitor Cell Transplantation.

Nucleated red blood cells in infants of smoking mothers

Very few data are available on longitudinal renal growth in small for gestational age (SGA) infants born at term. The aim of this prospective study was to estimate comparatively the renal growth in SGA infants and in infants born appropriate for gestational age (AGA) during the first 2 years of life. The study comprised groups of SGA and AGA infants with a gestational age (GA) of 36-41 weeks. The SGA group was classified into two subgroups of symmetrical and asymmetrical neonates according to the ponderal index. Serial renal ultrasonography (US) was performed at the ages of 41 weeks corrected age [GA (in weeks) plus age after birth (in weeks)] and at 3, 6, 12 and 24 months of chronological age and kidney length (KL) was related to other anthropometric indices. A total of 312 infants participated in the study out of which 197 were SGA, and a total number of 802 measurements were performed. The symmetrical SGA infants and, to a lesser degree, the asymmetrical SGA infants had smaller kidneys at birth compared with the AGA infants (P < 0.0001 and P < 0.001, respectively). The symmetrical SGA infants had a lower body weight (BW) (P < 0.001, P < 0.01) and crown-heel length (CHL) (P < 0.01, P < 0.05) than controls at the ages of 12 and 24 months of chronological age. The asymmetrical SGA infants had a lower BW (P < 0.01, P < 0.05) than controls at the ages of 12 and 24 months of chronological age. On the contrary, the KL in both SGA groups was not different from that of the AGA infants after the 41st week of corrected age and up to the 2nd year of life. SGA term infants had shorter KL at birth compared with AGA infants but a similar length from the 3rd to the 24th month of life. Early catch-up kidney growth was observed in both SGA groups and is more prominent in the symmetrical SGA infants. This observation may represent either an accelerated renal maturation process or early compensatory kidney hypertrophy in this group of infants.

An association between intrauterine hypoxia and increased nucleated red blood cell (RBC) counts in the peripheral circulation has long been acknowledged. Higher counts reportedly are especially likely in neurologically impaired newborn infants. This study aimed at determining the effect of acute, severe hypoxia on peripheral nucleated RBC counts in the fetal rat. Maternal animals were randomized to either 2 hours of exposure in a hypoxia chamber or exposure to room air in a control chamber. The test chamber contained 9% oxygen, 3% carbon dioxide, and balanced nitrogen. Cesarean deliveries were carried out immediately after exposure and then at intervals up to 60 hours. There were 56 fetuses in each group. No differences in nucleated RBC counts were apparent immediately after hypoxic exposure, but counts were significantly higher in the hypoxia group 12 and 24 hours after exposure. Counts in the 2 groups did not differ significantly 36, 48, or 60 hours after exposure. Like in studies of the human fetus, nucleated RBC counts decreased with advancing fetal age. Near-term fetal rats in this study exhibited a delayed but transient increase in nucleated RBC counts in the peripheral circulation after an acute hypoxic episode. It may be that an increased nucleated RBC count will be a useful marker for fetal brain injury of hypoxic origin.

Using a method described earlier, the evaporation rate (ER) from the skin was studied at different ambient humidities in 14 full-term and 10 pre-term small for gestational age (SGA) infants. Transepidermal water loss (TEWL) was estimated in 25 SGA infants born after 30-40 weeks of gestation. Comparisons were made with infants appropriate for gestational age (AGA). A linear relationship was found between ER and ambient humidity in full-term SGA infants, but with lower ER values than in AGA infants. Lower ER values were also found in moderately pre-term SGA infants at different ambient humidities. ER was higher at lower ambient humidities in both SGA and AGA infants. In full-term and moderately pre-term SGA infants TEWL was lower than in corresponding AGA infants.

Nucleated red blood cell count in the differentiation of fetuses with pathologic growth restriction from healthy small-for-gestational-age fetuses

To evaluate the impact of serum insulin-like growth factor-1 (IGF-1) levels on cardiac function in small for gestational age (SGA) infants. This is a prospective, observational study. Serum IGF-1 levels at birth and echocardiography measurements at 1 week of age were compared between SGA and appropriate for gestational age (AGA) infants. Thirty-one SGA infants and 27 AGA infants were enrolled. Serum IGF-1 levels were lower in the SGA infants than in the AGA infants. SGA infants had lower mitral lateral annular systolic (S') and early diastolic (E') tissue Doppler imaging velocities compared with AGA infants (S', 5.1 ± 0.9 vs 5.7 ± 1.2 cm/s; E', 6.1 ± 1.5 cm/s vs 7.1 ± 1.3 cm/s; p < 0.05). Serum IGF-1 levels positively correlated with E' velocity in the entire population (r = 0.44, p < 0.001) and in SGA infants (r = 0.39, p < 0.05). In multivariate linear regression analysis, serum IGF-1 and S' velocity were independently associated with E' velocity in the entire population and in SGA infants. Decreased serum IGF-I levels could account for cardiac diastolic dysfunction in SGA infants.

Adiponectin, a novel adipocytokine with insulin sensitizing properties, is inversely related to obesity and insulin resistance in adults. We recently reported large variations in weight gain and insulin sensitivity during the first year in infants born small for gestational age (SGA) or appropriate for gestational age (AGA). We now determined whether adiponectin levels were related to postnatal growth and insulin sensitivity in a prospective cohort followed from birth to two years old (n = 85) (55 female/30 male, 65 SGA/20 AGA). Serum adiponectin levels at one year and two years were higher compared to reported levels in adults and older children, and decreased from one year (21.6 +/- 0.6 microg/ml) to two years (15.7 +/- 0.7 microg/ml) (p < 0.05). At two years adiponectin levels were lower in females (15.3 +/- 0.4 microg/ml) than males (16.4 +/- 0.6 microg/ml) (p < 0.05), but no gender difference was seen in leptin or insulin levels. No differences in adiponectin levels were seen between SGA and AGA infants at one or two years. However, in SGA infants changes in adiponectin between one to two years old were inversely related to weight gain (r = -0.310, p < 0.05). Changes in leptin levels between one to two years were positively related to weight gain in both SGA and AGA infants (r = 0.450 and r = 0.500 respectively, both p < 0.05). Adiponectin levels were unrelated to insulin levels at one or two years, nor to change in insulin levels between one to two years. In multiple regression analysis, adiponectin levels were related only to postnatal age; omitting age from the model, the determinants of higher adiponectin levels were male gender (p = 0.03), lower postnatal body weight (p < 0.001), and higher birth weight SD score (p = 0.004). In conclusion, fall in serum adiponectin levels during the first two years of life were related to increasing age and greater weight gain SGA infants, but were unrelated to insulin sensitivity.

To understand the growth and development status and differences between small for gestational age (SGA) and appropriate for gestational age (AGA) preterm infants during corrected ages 0-24 months, and to provide a basis for early health interventions for preterm infants. A retrospective study was conducted, selecting 824 preterm infants who received regular health care at the Guangzhou Women and Children's Medical Center from July 2019 to July 2022, including 144 SGA and 680 AGA infants. The growth data of SGA and AGA groups at birth and corrected ages 0-24 months were analyzed and compared. The SGA group had significantly lower weight and length than the AGA group at corrected ages 0-18 months (P<0.05), while there were no significant differences between the two groups at corrected age 24 months (P>0.05). At corrected age 24 months, 85% (34/40) of SGA and 79% (74/94) of AGA preterm infants achieved catch-up growth. Stratified analysis by gestational age showed that there were significant differences in weight and length at corrected ages 0-9 months between the SGA subgroup with gestational age <34 weeks and the AGA subgroups with gestational age <34 weeks and 34 weeks (P<0.05). In addition, the weight and length of the SGA subgroup with gestational age 34 weeks showed significant differences compared to the AGA subgroups with gestational age <34 weeks and 34 weeks at corrected ages 0-18 months and corrected ages 0-12 months, respectively (P<0.05). Catch-up growth for SGA infants with gestational age <34 weeks and 34 weeks mainly occurred at corrected ages 0-12 months and corrected ages 0-18 months, respectively. SGA infants exhibit delayed early-life physical growth compared to AGA infants, but can achieve a higher proportion of catch-up growth by corrected age 24 months than AGA infants. Catch-up growth can be achieved earlier in SGA infants with a gestational age of <34 weeks compared to those with 34 weeks.

Objective To investigate the incidence of hyperbilirubinemia in late preterm newborns and their perinatal management. Methods From October 2013 to March 2015, a total of 35 cases of late preterm newborns who were diagnosed as hyperbilirubinemia were selected from 276 inpatient of late preterm newborns in Department of Neonatology, West China Second University Hospital, Sichuan University were included in study group, and another 35 patients who had not been diagnosed as hyperbilirubinemia were selected randomly from the other 241 inpatient cases and were included in control group by isometric sampling method. Retrospective analysis method was used to collect the clinical data of two groups and to analyze the following items. ①To compare the constituent ratios of gender, gestational age at birth, day age at the time of admission, admission ways, appropriate for gestational age (AGA) infants, small for gestational age (SGA) infants, large for gestational age (LGA) infants, delivery modes, and the incidences of premature rupture of membrane, intrauterine or postnatal asphyxia, cephalohematoma, pregnancy diseases in pregnant women between study group and control group by chi-square method or Fisher exact probability method. ②Incidence of hyperbilirubinemia among 276 cases of late preterm newborns in the study, and the relationship with the gender were analyzed. ③The constituent ratios of gender, day age at the time of admission, admission ways, gestational age at birth, AGA or LGA infants, delivery modes, birth institutions, and the incidences of severe and extremely severe highperbilirubinemia, concomitant diseases or causes of disease, bilirubin encephalopathy and readmission etc. in study group were analyzed. Results ①There were significant differences between two groups among the constituent ratios of gestational age at birth, day age at the time of admission, admission ways, premature types, delivery modes, and the incidences of premature rupture of membranes and intrauterine or postnatal asphyxia (χ2=12.011, P=0.002; χ2=16.931, P 0.05), respectively. ②Among the 276 cases of late preterm newborns included in the study, hyperbilirubinemia incidence was 12.7% (35/276). Gender ratio of male and female was 1.9∶1 in 35 cases of late preterm newborns diagnosed as hyperbilirubinemia. ③Among the 35 hyperbilirubinemia of late preterm newborns in study group, the gestational age at birth was 34+ 0-36+ 6 weeks, severe and extremely severe hyperbilirubinemia both were 15 cases, which accounting for 85.7% (30/35), there was none of dangerous hyperbilirubinemia neonates. And hyperbilirubinemia of late preterm newborns whose age≤7 d was more than that of age>7 d at the time of admission, and the proportion of late preterm newborns of age≤7 d was 60.0% (21/35), after discharge from rooming-in periods, they rehospitalized from outpatient and emergency department into neonatal department, and their rehospitalized rate was 94.3% (33/35). Level of birth medical institutions of late preterm newborns in study group between grade second and grade third was 45.7% (16/35) and 48.6% (17/35), respectively. Among the accompanied diseases or causes of 35 hyperbilirubinemia of late preterm newborns in study group, infection, ABO blood group incompatible hemolytic disease, glucose-6-phosphate dehydrogenase (G6PD) deficiency, cephalohematoma and multiple causes of diseases accounted for 17.1% (6/35), 11.4% (4/35), 5.7% (2/35), 2.9% (1/35), 5.7%(2/35), respectively; but there was the other 57.1% (20/35) still could not found a clear cause of hyperbilirubinemia. The incidence of bilirubin encephalopathy of late preterm newborns in study group was as high as 40% (14/35), and blood exchange rate was also as high as 62.9% (22/35). Conclusions In late preterm newborns with hyperbilirubinemia, the rate of severe and extremely severe hyperbilirubinemia, and incidence of bilirubin encephalopathy are high. And the rates of males, age≤7 d at the time of admission, 35+ 0-35+ 6 gestational weeks at birth, AGA infants, natural birth, complications were also high. Therefore, it is important to emphasize the training of health care workers for normative management of neonatal hyperbilirubinemia, and strengthening neonatal icterus monitoring perinatal management and other measures, so as to reduce disability and improve the life quality of late preterm newborns with hyperbilirubinemia. Key words: Hyperbilirubinemia; Severe and extremely severe hyperbilirubinemia; Kernicterus; Perinatal management; Late preterm newborns

The objective of this study was to test the hypothesis that in discordant twins, the smaller infant has higher absolute nucleated red blood cell (RBC) count than the larger sibling. We compared absolute nucleated RBC counts, hematocrits, absolute leukocyte counts, absolute granulocyte counts, absolute lymphocyte counts, RBC counts and platelet counts obtained in the first 12 hours of life in 30 discordant twin sets. The smaller infant had a higher absolute nucleated red blood cell count and lower platelet counts than its larger sibling. Platelet counts correlated inversely with absolute nucleated RBC counts ( R(2) = 24.5%; p < 0.001) and absolute nucleated RBCs correlated directly with percent intertwin weight differences ( R(2) = 17.8%; p = 0.02). In discordant twins, the smaller infant has higher absolute nucleated RBC count and lower platelet counts than the larger sibling. We speculate that the hematologic alterations in the smaller fetus are linked to relative fetal hypoxia.

ObjectiveElevated nucleated red blood cell (NRBC) count is introduced as a potential marker of intra-uterine growth restriction (IUGR). To investigate the probable association regardless of any known underlying disease, we aimed to study disturbances in NRBC count in infants experiencing idiopathic IUGR.Materials and methodsTwenty three infants regarded IUGR without any known cause were chosen to be compared to 48 normal neonates. Blood samples were collected instantly after birth and the same measurements were done in both groups.ResultsNRBC count/100 white blood cells was significantly higher in the IUGR group (P value < 0.001). pH measurements did not reveal any significant difference.ConclusionIncreased NRBC count in cases of idiopathic IUGR in absence of chronic hypoxia could strengthen its predictive value suggested in previous studies. It could help early IUGR detection and beneficial intervention.

Our purpose was to evaluate whether maternal and fetal hepatocyte growth factor (HGF) concentrations in pregnancies with small for gestational age (SGA) infants are different from those in pregnancies with appropriate for gestational age (AGA) infants. Maternal and fetal circulating HGF concentrations were compared between 55 pregnancies with AGA infants and 16 pregnancies with SGA infants at birth. HGF concentrations were measured from maternal and cord venous blood samples using an enzyme-linked immunosorbent assay. Umbilical artery blood pH and oxidative pressure (PO2) were also measured. Maternal circulating HGF concentrations (0.60+/-0.35 ng/ml) in pregnancies with SGA infants were significantly lower than those (0.91+/-0.44 ng/ml) in pregnancies with AGA infants (P = 0.012). There were no significant differences in fetal circulating HGF concentrations between both groups. No significant differences in umbilical artery blood pH and PO2 were found between both groups. These results suggest that the maternal serum circulating HGF concentration has a significant role in fetal growth during pregnancy.