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DOI: 10.1055/s-0041-1726317
Nucleated Red Blood Cells as Markers of Perinatal Adaptation in Preterm Neonates Receiving Minimally Invasive Surfactant Therapy
Funding None.![](https://www.thieme-connect.de/media/ajp/202216/lookinside/thumbnails/10-1055-s-0041-1726317_200700-1.jpg)
Abstract
Objective The study aimed to assess the association of nucleated red blood cells (NRBC), a surrogate of intrauterine hypoxia, and elevated pulmonic vascular resistance (E-PVR) and oxygen requirement after minimally invasive surfactant therapy (MIST).
Study Design Retrospective study of a cohort of preterm neonates that received MIST in a single unit.
Results NRBC were measured in 65 of 75 (87%) neonates administered MIST during the period. In total, 22 of 65 (34%) infants had pre-MIST echocardiography (ECHO).
Neonates with elevated NRBC (predefined as >5 × 109/L, n = 16) required higher post-MIST fraction of inspired oxygen (FiO2) than neonates with normal NRBC (<1 × 109/L, n = 17; FiO2 = 0.31 ± 0.10 and 0.24 ± 0.04, respectively, p = 0.02).
NRBC correlated positively with % of time in right to left ductal shunt (r = 0.51, p = 0.052) and inversely with right ventricular stroke volume (r = −0.55, p = 0.031) and time to peak velocity to right ventricular ejection time ratio (r = −0.62, p < 0.001).
Conclusion Elevated NRBC are associated with elevated FiO2 after MIST and elevated E-PVR. Intrauterine hypoxia may impact postnatal circulatory adaptations and oxygen requirement.
Key Points
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Post-MIST FiO2 requirements are significantly higher in infants with elevated NRBC.
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NRBC correlates positively with elevated PVR in neonates requiring.
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Intrauterine hypoxia may play a role in postnatal circulatory adaptations in neonates with RDS.
Keywords
Respiratory Distress Syndrome - persistent pulmonary hypertension - pulmonary vascular resistance - functional echocardiography - erythropoietinNote
Abstract containing some of the study information was accepted to the PSANZ conference in Sydney 2020.
Publication History
Received: 05 August 2020
Accepted: 01 February 2021
Article published online:
23 March 2021
© 2021. Thieme. All rights reserved.
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References
- 1 Sweet DG, Carnielli V, Greisen G. et al. European consensus guidelines on the management of respiratory distress syndrome - 2019 update. Neonatology 2019; 115 (04) 432-450
- 2 de Boode WP, Singh Y, Molnar Z. et al; European Special Interest Group ‘Neonatologist Performed Echocardiography’ (NPE). Application of Neonatologist Performed Echocardiography in the assessment and management of persistent pulmonary hypertension of the newborn. Pediatr Res 2018; 84 (Suppl. 01) 68-77
- 3 Amarilyo G, Mimouni FB, Oren A. et al. Prohepcidin concentrations and erythroid progenitors in cord blood of appropriate versus small for gestational age neonates. J Perinatol 2010; 30 (06) 396-398
- 4 Axt-Fliedner R, Hendrik HJ, Schmidt W. Nucleated red blood cell counts in growth-restricted neonates with absent or reversed-end-diastolic umbilical artery velocity. Clin Exp Obstet Gynecol 2002; 29 (04) 242-246
- 5 Shuper A, Mimouni F, Merlob P, Zaizov R, Reisner SH. Thrombocytopenia in small-for-gestational-age infants. Acta Paediatr Scand 1983; 72 (01) 139-140
- 6 Papamatheakis DG, Blood AB, Kim JH, Wilson SM. Antenatal hypoxia and pulmonary vascular function and remodeling. Curr Vasc Pharmacol 2013; 11 (05) 616-640
- 7 Nitzan I, Kasirer Y, Mimouni FB. et al. Elevated nucleated red blood cells in neonates with down syndrome and pulmonary hypertension. J Pediatr 2019; 213: 232-234
- 8 Klebermass-Schrehof K, Wald M, Schwindt J. et al. Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity. Neonatology 2013; 103 (04) 252-258
- 9 Aldana-Aguirre JC, Pinto M, Featherstone RM, Kumar M. Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2017; 102 (01) F17-F23
- 10 Dargaville PA, Aiyappan A, Cornelius A, Williams C, De Paoli AG. Preliminary evaluation of a new technique of minimally invasive surfactant therapy. Arch Dis Child Fetal Neonatal Ed 2011; 96 (04) F243-F248
- 11 Green DW, Hendon B, Mimouni FB. Nucleated erythrocytes and intraventricular hemorrhage in preterm neonates. Pediatrics 1995; 96 (3 Pt 1): 475-478
- 12 Green DW, Mimouni F. Nucleated erythrocytes in healthy infants and in infants of diabetic mothers. J Pediatr 1990; 116 (01) 129-131
- 13 Perrone S, Vezzosi P, Longini M. et al; Gruppo di Studio di Ematologia Neonatale della Società Italiana di Neonatologia. Nucleated red blood cell count in term and preterm newborns: reference values at birth. Arch Dis Child Fetal Neonatal Ed 2005; 90 (02) F174-F175
- 14 Sehgal A, Bhatia R, Roberts CT. Cardiorespiratory physiology following minimally invasive surfactant therapy in preterm infants. Neonatology 2019; 116 (03) 278-285
- 15 Yeruchimovich M, Dollberg S, Green DW, Mimouni FB. Nucleated red blood cells in infants of smoking mothers. Obstet Gynecol 1999; 93 (03) 403-406
- 16 Littner Y, Mandel D, Sheffer-Mimouni G, Mimouni FB, Deutsch V, Dollberg S. Nucleated red blood cells in infants of mothers with asthma. Am J Obstet Gynecol 2003; 188 (02) 409-412
- 17 Green DW, Elliott K, Mandel D, Dollberg S, Mimouni FB, Littner Y. Neonatal nucleated red blood cells in discordant twins. Am J Perinatol 2004; 21 (06) 341-345
- 18 Rozance PJ, Seedorf GJ, Brown A. et al. Intrauterine growth restriction decreases pulmonary alveolar and vessel growth and causes pulmonary artery endothelial cell dysfunction in vitro in fetal sheep. Am J Physiol Lung Cell Mol Physiol 2011; 301 (06) L860-L871
- 19 Gross TL, Sokol RJ, Wilson MV, Kuhnert PM, Hirsch V. Amniotic fluid phosphatidylglycerol: a potentially useful predictor of intrauterine growth retardation. Am J Obstet Gynecol 1981; 140 (03) 277-281
- 20 Naeye RL, Harcke Jr HT, Blanc WA. Adrenal gland structure and the development of hyaline membrane disease. Pediatrics 1971; 47 (04) 650-657
- 21 Gortner L, Wauer RR, Stock GJ. et al. Neonatal outcome in small for gestational age infants: do they really better?. J Perinat Med 1999; 27 (06) 484-489
- 22 Nobile S, Marchionni P, Carnielli VP. Neonatal outcome of small for gestational age preterm infants. Eur J Pediatr 2017; 176 (08) 1083-1088