Abstract
Purpose: nucleated red blood cell counts are increased in several hypoxic conditions. The authors aimed to establish if there is a correlation between erythroblast counts in the umbilical vein of newborns and the presence of perinatal hypoxia detected by acid-base balance parameters. Methods: blood samples were obtained from the umbilical vein of pregnant subjects with at least 37 weeks of gestation attended at the Hospital de Alvorada-RS, just before the newborns' first breathing movement. Part of the blood was placed in an EDTA-containing vial and white and red blood cells were analyzed. The remaining amount of blood was aspirated into insulin type syringe previously washed with heparin and pH, pO2, pCO2 and acid-base excess/deficit were analyzed. Slides were also prepared with the panoptic stain for visual identification and count of the erythroblast number. The erythroblast/leukocyte ratio was calculated. Results: of the 158 cases included in the study, 55 were considered free of perinatal hypoxia. In this population, the average erythroblast rate was 3.9% with a standard deviation of 2.8%. The minimum and maximum values were 0% and 10%, respectively. When considering all the cases, the average was 5.7%, with a standard deviation of 5.3%. The minimum and maximum values were 0% and 28%, respectively. Application of Pearson's test for the analysis of the erythroblast rate and acid-base parameters showed a significant correlation for pH and pCO2. The construction of a Receiver Operation Curve showed that for an erythroblast rate of 5%, a 7.25-pH cutoff yields a sensitivity of 54% and a specificity of 56%. Out of the 23 newborns whose normoblast rate was greater than 10%, there was acidemia in 7 (30.4%), 11 (48.7%) were large for gestational age, 3 (13%) were small for gestational age, 7 (30.4%) were anemic, and in 3 (13%) there were no abnormalities. Conclusions: in newborns from uncomplicated pregnancies and deliveries, the erythroblast rate was less than 10%. When it was greater than 10%, a correlation was found mainly with large or small for gestational age, fetal anemia and acidemia.
Highlights
Results: of the 158 cases included in the study, 55 were considered free of perinatal hypoxia
Purpose: nucleated red blood cell counts are increased in several hypoxic conditions
The authors aimed to establish if there is a correlation between erythroblast counts in the umbilical vein of newborns and the presence of perinatal hypoxia detected by acid-base balance parameters
Summary
Importance of Erythroblast Count in the Newborn’s Umbilical Vein as a Hematological Marker For Perinatal Hypoxia. Do total de 158 casos arrolados durante o período descrito, 55 preencheram os seguintes critérios: a gestação transcorreu sem anormalidades e, portanto, foi rotulada de baixo risco; o trabalho de parto teve início espontâneo, transcorreu sem uso de medicamentos e teve duração menor do que 12 horas; o período de rotura das membranas não ultrapassou 18 horas; o parto foi normal; não houve sinais clínicos (presença de mecônio) nem cardiotocográficos (alterações da freqüência cardíaca fetal basal) de estado fetal não-tranquilizador[15]; o índice de Apgar foi igual ou maior do que 7 no Eritroblasto como marcador de hipóxia primeiro e quinto minutos de vida; o pH da veia umbilical foi igual ou maior do que 7,25 e o déficit de bases não foi maior do que –6 mEq/L; o hematócrito do sangue da veia umbilical foi igual ou maior do que 40%; a avaliação do recém-nascido, pelo método de Capurro, caracterizou idade entre 37 e 41 semanas; o exame neurológico ao nascimento foi normal; o peso ao nascimento situouse entre os percentis 50 e 75 para idades entre 37 e 41 semanas respectivamente, de uma curva elaborada a partir da população de 2.875 crianças nascidas no Hospital de Alvorada, no período de outubro de 1998 a outubro 1999, pela aplicação do Programa SIP6; não houve intercorrências no período neonatal e a alta da criança coincidiu com a da mãe. Tabela 1 - Dados obstétricos e perinatais dos 158 casos estudados
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