MacQueen B C, Christensen R D, Yoder B A, Henry E, Baer V L, Bennett S T, Yaish H M
Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
Women and Newborn's Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.
J Perinatol. 2016 Oct;36(10):843-8. doi: 10.1038/jp.2016.92. Epub 2016 Jun 9.
The neutrophil 'left shift' can be measured via the immature to total (I/T) neutrophil ratio or the absolute bands per μl using a manual differential count. It can also be measured from an automated differential count by the immature granulocyte percentage (IG%) or the absolute IG per μl. In neonates, it is unknown if the manual or automated differential count is superior.
We directly compared complete blood counts (CBCs) with manual and automated differential counts from infants <90 days old, and documented whether or not each neonate was infected. We developed reference intervals for I/T ratio, bands per μl, IG% and IG per μl using values from non-infected neonates.
The database had 10 714 CBCs. The upper reference interval for I/T ratio was 0.29 in the first 48 h and 0.31 thereafter; bands per μl was 3710 μl(-1) in the first 48 h and 1785 μl(-1) thereafter. IG% was 6.2% then 4.2%; IG per μl was 1460 μl(-1) then 613 μl(-1). Statistical performances of the four methods were equivalent for identifying infection.
We developed reference intervals for four methods of quantifying a neonate's 'left shift'. The information from automated differentials is not inferior to that from manual differentials in identifying infections, but automated differentials have the advantages of a larger sample size, being less expensive, and faster performance times.
中性粒细胞“核左移”可通过未成熟与总（I/T）中性粒细胞比值或每微升绝对杆状核细胞数，采用手工分类计数法进行测量。也可通过未成熟粒细胞百分比（IG%）或每微升绝对未成熟粒细胞数，从自动分类计数中进行测量。在新生儿中，尚不清楚手工分类计数法还是自动分类计数法更具优势。
我们直接比较了90日龄以内婴儿的全血细胞计数（CBC）结果，以及手工和自动分类计数结果，并记录每个新生儿是否感染。我们使用未感染新生儿的值，制定了I/T比值、每微升杆状核细胞数、IG%和每微升IG的参考区间。
数据库中有10714份全血细胞计数结果。I/T比值的上参考区间在前48小时为0.29，之后为0.31；每微升杆状核细胞数在前48小时为3710μl⁻¹，之后为1785μl⁻¹。IG%分别为6.2%和4.2%；每微升IG分别为1460μl⁻¹和613μl⁻¹。在识别感染方面，四种方法的统计性能相当。
我们制定了四种量化新生儿“核左移”方法的参考区间。在识别感染方面，自动分类计数法提供的信息并不逊于手工分类计数法，但自动分类计数法具有样本量更大、成本更低和检测速度更快的优势。
