Baschat Ahmet A, Gungor Sadettin, Kush Michelle L, Berg Christoph, Gembruch Ulrich, Harman Christopher R
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, MD 21201-1703, USA.
Am J Obstet Gynecol. 2007 Sep;197(3):286.e1-8. doi: 10.1016/j.ajog.2007.06.020.
Nucleated red blood cells (NRBC) are fetal hematologic markers for placental dysfunction, hypoxemia, and asphyxia. NRBC count elevation at birth or persistence is linked statistically to adverse outcome, but clinical predictive value is variable. We studied novel indices to better define overall magnitude of NRBC response.
Peripheral NRBC count was obtained from preterm (<34 weeks of gestation) growth-restricted neonates within 2 hours of life. Daily counts and duration of NRBC count >30/100 white blood cells were determined. Mean counts (NRBC-mean), area under the curve (NRBC-AUC), and declination (NRBC-slope) were analyzed over week 1. NRBC parameters were related to major morbidity (bronchopulmonary dysplasia, grade III/IV intraventricular hemorrhage, necrotizing enterocolitis included) and neonatal death (NND).
Twenty-two of 176 patients (12.5%) had acidosis. Complications included bronchopulmonary dysplasia (n = 36; 20.5%), intraventricular hemorrhage (n = 18; 10.2%), necrotizing enterocolitis (n = 18; 10.2%), NND (n = 18; 10.2%). NRBC-AUC and NRBC-mean correlated most strongly with pH, birthweight, and gestational age (Pearson coefficient -0.45 to -0.18; all P < .001). NRBC-AUC varied most between nonmorbid and morbid; NRBC-mean varied most between survivors and NND (all P < .001). NRBC persistence strongly predicted NND: clearance by day 4 was achieved by 80% of survivors and only 35% of NNDs. Logistic regression identified prematurity and persistent NRBC counts as primary morbidity determinants (r2 = 0.56; P < .01). Although the importance of individual NRBC counts varied, day-4 NRBC counts of >70 predicted morbidity best (sensitivity, 82%; specificity, 96%). Presence of morbidity and birthweight were prime determinants of death (r2 = 0.42; P < .01).
Simple daily NRBC counts provide clinical information that is equivalent to more complicated methods. The importance of prematurity and growth are emphasized, but elevated NRBC counts beyond day 3 are relevant independent predictors of adverse outcome.
有核红细胞（NRBC）是胎盘功能不全、低氧血症和窒息的胎儿血液学标志物。出生时或持续存在的NRBC计数升高在统计学上与不良结局相关，但临床预测价值存在差异。我们研究了新的指标以更好地定义NRBC反应的总体程度。
在出生后2小时内从早产（<34周妊娠）生长受限的新生儿获取外周血NRBC计数。确定每日计数以及NRBC计数>30/100白细胞的持续时间。在第1周内分析平均计数（NRBC-mean）、曲线下面积（NRBC-AUC）和下降率（NRBC-slope）。NRBC参数与主要发病率（包括支气管肺发育不良、III/IV级脑室内出血、坏死性小肠结肠炎）和新生儿死亡（NND）相关。
176例患者中有22例（12.5%）出现酸中毒。并发症包括支气管肺发育不良（n = 36；20.5%）、脑室内出血（n = 18；10.2%）、坏死性小肠结肠炎（n = 18；10.2%）、NND（n = 18；10.2%）。NRBC-AUC和NRBC-mean与pH、出生体重和胎龄的相关性最强（Pearson系数-0.45至-0.18；均P <.001）。NRBC-AUC在无病和患病之间差异最大；NRBC-mean在幸存者和NND之间差异最大（均P <.001）。NRBC持续存在强烈预测NND：4天时80%的幸存者实现清除，而NND中仅35%实现清除。逻辑回归确定早产和持续的NRBC计数为主要发病决定因素（r2 = 0.56；P <.01）。尽管个体NRBC计数的重要性各不相同，但第4天NRBC计数>70对发病率的预测最佳（敏感性82%；特异性96%）。发病情况和出生体重是死亡的主要决定因素（r2 = 0.42；P <.01）。
简单的每日NRBC计数提供的临床信息与更复杂的方法相当。强调了早产和生长的重要性，但第3天之后NRBC计数升高是不良结局的相关独立预测因素。
