Schmutz N, Henry E, Jopling J, Christensen R D
Intermountain Healthcare, Ogden, UT 84403, USA.
J Perinatol. 2008 Apr;28(4):275-81. doi: 10.1038/sj.jp.7211916. Epub 2008 Jan 17.
Upper and lower reference limits for blood neutrophil concentrations of neonates were reported by Manroe, Rosenfeld and co-workers in 1979 and by Mouzinho, Rosenfeld and co-workers in 1994. Studies by Carballo and co-workers and Maynard and co-workers suggested that at high altitude a much higher upper limit of values occurs, and that neutrophilia is often diagnosed inappropriately, at high altitude, if the Manroe and Mouzinho charts are used.
We revisited the Manroe and Mouzinho charts using modern cell counting instrumentation and very large sample sizes. This was accomplished with data from an 18-hospital health-care system, at hospitals averaging 4,800 feet above sea level. Data were obtained from neonates in the first 10 days following birth, using tests performed on a single type of automated blood cell counter (Beckman Coulter LH 750, Fullerton, CA, USA). To obtain a description of 'expected values,' patients with the following diagnoses, known to have a high proportion of abnormal neutrophil counts, were excluded from the analysis; (1) maternal pregnancy-induced hypertension, (2) early-onset bacterial sepsis, (3) a discharge diagnosis of congenital neutropenia and (4) trisomy 21, 18 or 13.
Blood neutrophil concentrations were tabulated from 30 354 tests performed on neonates of 23 to 42 weeks gestation, with dates of birth between 1 January 2004 and 31 May 2007. The reference range charts generated from these data have much higher upper value limits than do the Manroe and Mouzinho charts, and are similar to the high-altitude reports of Carballo and co-workers and Maynard and co-workers. Neonates whose mothers labored before delivery had significantly higher neutrophil counts (averaging 3,500 neutrophils per mul higher, P<0.0001; comparing cesarean section deliveries with vs without labor). Females had significantly higher counts (averaging 2,000 neutrophils per mul higher) than males (P<0.0001). Counts did not differ on the basis of racial/ethnic group.
The figures of this report describe the expected ranges for blood neutrophil concentrations over the first 10 days of life among neonates of 23 to 42 weeks gestation at high altitude.
1979年，门罗、罗森菲尔德及其同事报告了新生儿血液中性粒细胞浓度的上下参考限值，1994年，穆齐尼奥、罗森菲尔德及其同事也进行了相关报告。卡瓦略及其同事以及梅纳德及其同事的研究表明，在高海拔地区，中性粒细胞值的上限要高得多，并且如果使用门罗和穆齐尼奥的图表，在高海拔地区中性粒细胞增多症常常被不恰当地诊断。
我们使用现代细胞计数仪器和非常大的样本量重新审视了门罗和穆齐尼奥的图表。这是通过一个由18家医院组成的医疗保健系统的数据完成的，这些医院平均海拔4800英尺。数据来自出生后头10天的新生儿，使用的是对单一类型的自动血细胞计数器（美国加利福尼亚州富勒顿市贝克曼库尔特LH 750）进行的检测。为了获得“预期值”的描述，分析中排除了以下已知中性粒细胞计数异常比例较高的诊断患者：（1）母亲妊娠高血压；（2）早发性细菌性败血症；（3）出院诊断为先天性中性粒细胞减少症；（4）21、18或13三体综合征。
对2004年1月1日至2007年5月31日出生的妊娠23至42周新生儿进行的30354次检测记录了血液中性粒细胞浓度。根据这些数据生成的参考范围图表的上限值比门罗和穆齐尼奥的图表高得多，并且与卡瓦略及其同事以及梅纳德及其同事的高海拔报告相似。母亲在分娩前有产程的新生儿中性粒细胞计数显著更高（剖宫产有无产程相比，平均每微升高3500个中性粒细胞，P<0.0001）。女性的计数（平均每微升高2000个中性粒细胞）显著高于男性（P<0.0001）。计数在种族/族裔群体方面没有差异。
本报告中的数据描述了高海拔地区妊娠23至42周新生儿出生后头10天血液中性粒细胞浓度的预期范围。
