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  • Title: Nucleated red blood cell and platelet counts in asphyxiated neonates sufficient to result in permanent neurologic impairment.
    Author: Phelan JP, Kirkendall C, Korst LM, Martin GI.
    Journal: J Matern Fetal Neonatal Med; 2007 May; 20(5):377-80. PubMed ID: 17674240.
    Abstract:
    OBJECTIVE: Recent research has suggested that a nucleated red blood cell (NRBC) count >or=26 per 100 white blood cells (%) or the development of a platelet count <or=100,000 per mm(3) within five days of birth is characteristic of neonates who have experienced acute birth asphyxia. STUDY DESIGN: Study cases were from the population defined in a prior publication (Prenat Neonat Med 1997;2:286). The impaired neonates were separated into three groups: group 1, persistent non-reactive fetal heart rate (FHR) pattern from admission until delivery; group 2, reactive FHR pattern on admission followed by a tachycardia, non-reactivity, repetitive variable or late decelerations, and usually a loss of variability; group 3, cases with a reactive FHR pattern on admission followed by a sudden, rapid and sustained deterioration of the FHR usually in response to a hypoxic sentinel event that lasted until delivery or a bradycardia on admission. The FHR pattern in group 3 is considered most consistent with acute birth asphyxia. We then examined these FHR groups with respect to the presence of hematologic injury. Chi-square testing was used to describe differences among the study populations. RESULTS: Of the original 52 cases, sufficient hematologic data were available for 47. Of these, the proportion of cases with NRBC >or=26% was: group 1, 10/21 (47.6%); group 2, 0/14 (0%); group 3, 0/12 (0%). Those with a platelet count <or=100,000 per mm(3): group 1, 11/21 (52.4%); group 2, 2/14 (14.3%); group 3, 0/12 (0%). Group 1 was significantly more likely to have an NRBC count >or=26% than group 3 (p = 0.0135). A platelet count <or=100,000 per mm(3) within five days of birth was also significantly more likely to be encountered in group 1 as compared with group 3 (p = 0.0072). CONCLUSION: In cases of acute birth asphyxia, hematologic injury was infrequently encountered. Our findings suggest that a neonatal NRBC count >or=26% and/or a platelet count <or=100,000 per mm(3) within five days of birth is inconsistent with acute birth asphyxia.
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