Neonatal nucleated red blood cells are a marker for infants at risk for cerebral white matter injury

Abstract

FOR CEREBRAL WHITE MATTER INJURY ANADIR SILVA, RANDI SMITH, CHRISTOPH LEHMANN, CYNTHIA HOLCROFT, ERNEST GRAHAM, Johns Hopkins University, Obstetrics and Gynecology, Baltimore, Maryland, University of California, San Francisco, School of Medicine, Baltimore, Maryland, Johns Hopkins University, Pediatrics, Baltimore, Maryland, Johns Hopkins University, Gynecology and Obstetrics, Columbia, Maryland OBJECTIVE: Neonatal nucleated red blood cells (nnRBCs) are a marker of acute and chronic hypoxia, but also increase in inflammation. We sought to determine if nnRBC counts are associated with cerebral white matter (WM) injury in the preterm fetus. STUDY DESIGN: We identified infants with cerebral WM injury born at 23-34 weeks from 11/94-1/04. Each case was matched by gestational age with the next infant without WM injury. We excluded infants with aneuploidy or major anomalies. Data were analyzed by t-test and c, with P ! .05 considered significant. RESULTS: We identified 180 cases. Nnrbc count was done on admission to the NICU for 176/180 (97.8%) controls and 175/180 (97.2%) cases. Nonreassuring fetal heart tracing (36+70, 108+200, P = .001), absent/reversed end diastolic flow (39 + 80, 269 + 289, P= .001), meconium (48+98, 113+278, P = .01), IUGR (33 + 66, 205 + 249, P = .001), and culture + neonatal sepsis (37 + 76, 65 + 139, P = .02) were associated with significant increase in nnRBCs. CONCLUSION: Neonatal cerebral WM injury in the preterm fetus is associated with significant increase in nnRBC counts and culture + neonatal sepsis. Neonatal sepsis also was associated with higher nnRBC counts. While umbilical artery pH !7.0 was associated with increased nnRBC counts, it was not associated with increased WM injury.