Mouzinho A, Rosenfeld C R, Sánchez P J, Risser R
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063.
Pediatrics. 1994 Jul;94(1):76-82.
Healthy very-low-birth-weight neonates (VLBW, < or = 1500 g) exhibit a high incidence of neutropenia according to Manroe's reference ranges for neutrophil indices. Since these reference ranges may be inappropriate for VLBW neonates, we determined the reference ranges for circulating peripheral neutrophils in VLBW neonates between birth and 28 days of age.
Serial, timed peripheral white blood cell counts (n = 1788) were prospectively obtained between birth and 28 days from 193 inborn, VLBW neonates delivered between January 1 and December 31, 1990. Data were divided into neutrophil counts obtained prior to (n = 630) and after (n = 1158) 60 hours of age. After excluding counts from neonates with perinatal and/or neonatal complications, values from "normal" neonates were compared to Manroe's reference ranges. Where indicated new ranges were developed.
Although immature neutrophil (ATI) and immature:total neutrophil (I:T) values were within Manroe's reference ranges (P > .1) throughout the neonatal period, 67% of total neutrophil values (ATN) obtained prior to 60 hours of age were outside (P < .001) and 95% were considered neutropenic. Newly developed ATN reference ranges for VLBW neonates have a wider range of distribution compared to Manroe's results, primarily reflecting a decrease in the lower boundary. ATN values between 61 hours and 28 days also differed (P < .001), and new ranges had upper and lower boundaries of 6000 and 1100/mm3, respectively. Maternal hypertension was associated with neonatal neutropenia (P < .001) without abnormalities of ATI or I:T prior to day 3 of life; however, neutrophilia predominated after day 7. Between birth and 28 days > 70% of ATN values were abnormal in neonates with apnea, neutrophilia occurring in > 90% of counts; I:T values, however, were normal between 61 hours and 28 days.
Normal preterm VLBW neonates have ATN reference ranges that differ significantly from that for larger, older neonates, demonstrating the effects of development on neutrophil dynamics. The predictability of neonatal infection using these new reference ranges requires additional study.
根据门罗的中性粒细胞指数参考范围，健康的极低出生体重儿（VLBW，≤1500克）中性粒细胞减少症的发生率很高。由于这些参考范围可能不适用于极低出生体重儿，我们确定了出生至28日龄的极低出生体重儿循环外周血中性粒细胞的参考范围。
前瞻性地获取了1990年1月1日至12月31日期间出生的193例极低出生体重儿在出生至28日龄期间的系列定时外周血白细胞计数（n = 1788）。数据分为60小时龄之前（n = 630）和之后（n = 1158）获得的中性粒细胞计数。在排除有围产期和/或新生儿并发症的新生儿的计数后，将“正常”新生儿的值与门罗的参考范围进行比较。在有指示的情况下制定新的范围。
尽管在整个新生儿期未成熟中性粒细胞（ATI）和未成熟：总中性粒细胞（I：T）值均在门罗的参考范围内（P >.1），但60小时龄之前获得的总中性粒细胞值（ATN）中有67%超出（P <.001），95%被认为是中性粒细胞减少。与门罗的结果相比，新制定的极低出生体重儿ATN参考范围的分布范围更广，主要反映在下边界的降低。61小时至28日龄之间的ATN值也不同（P <.001），新范围的上边界和下边界分别为6000和1100/mm3。母亲高血压与新生儿中性粒细胞减少症相关（P <.001），在出生后第3天之前ATI或I：T无异常；然而，出生后第7天之后以中性粒细胞增多为主。在出生至28日龄期间，呼吸暂停新生儿中>70%的ATN值异常，>90%的计数中出现中性粒细胞增多；然而，61小时至28日龄之间I：T值正常。
正常早产极低出生体重儿的ATN参考范围与较大、年龄较大的新生儿有显著差异，表明发育对中性粒细胞动态的影响。使用这些新参考范围预测新生儿感染需要进一步研究。
