Bernstein P S, Minior V K, Divon M Y
Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY 10461-2373, USA.
Am J Obstet Gynecol. 1997 Nov;177(5):1079-84. doi: 10.1016/s0002-9378(97)70018-8.
The presence of elevated nucleated red blood cell counts in neonatal blood has been associated with fetal hypoxia. We sought to determine whether small-for-gestational-age fetuses with abnormal umbilical artery Doppler velocity waveforms have elevated nucleated red blood cell counts.
Hospital charts of neonates with the discharge diagnosis of small for gestational age (birth weight < 10th percentile) who were delivered between October 1988 and June 1995 were reviewed for antepartum testing, delivery conditions, and neonatal outcome. We studied fetuses who had an umbilical artery systolic/diastolic ratio within 3 days of delivery and a complete blood cell count on the first day of life. Multiple gestations, anomalous fetuses, and infants of diabetic mothers were excluded. Statistical analysis included the Student t test, chi 2 analysis, analysis of variance, and simple and stepwise regression.
Fifty-two infants met the inclusion criteria. Those with absent or reversed end-diastolic velocity (n = 19) had significantly greater nucleated red blood cell counts than did those with end-diastolic velocity present (n = 33) (nucleated red blood cells/100 nucleated cells +/- SD: 135.5 +/- 138 vs 17.4 +/- 23.7, p < 0.0001). These infants exhibited significantly longer time intervals for clearance of nucleated red blood cells from their circulation (p < 0.0001). They also had lower birth weights (p < 0.05), lower initial platelet count (p = 0.0006), lower arterial cord blood pH (p < 0.05), higher cord blood base deficit (p < 0.05), and an increased likelihood of cesarean section for "fetal distress" (p < 0.05). Multivariate analysis demonstrated that absent or reversed end-diastolic velocity (p < 0.0001) and low birth weight (p < 0.0001) contributed to the elevation of the nucleated red blood cell count, whereas gestational age at delivery was not a significant contributor.
We observed significantly greater nucleated red blood cell counts and lower platelet counts in small-for-gestational-age fetuses with abnormal umbilical artery Doppler studies. This may suggest that antenatal thrombotic events lead to an increased placental impedance. Fetal response to this chronic condition may result in an increased nucleated red blood cell count.
新生儿血液中核红细胞计数升高与胎儿缺氧有关。我们试图确定孕周小于胎龄且脐动脉多普勒速度波形异常的胎儿是否有核红细胞计数升高。
回顾了1988年10月至1995年6月期间出院诊断为孕周小于胎龄（出生体重<第10百分位数）的新生儿的医院病历，以了解产前检查、分娩情况和新生儿结局。我们研究了在分娩后3天内脐动脉收缩/舒张比以及出生第一天全血细胞计数的胎儿。排除多胎妊娠、畸形胎儿和糖尿病母亲的婴儿。统计分析包括Student t检验、卡方分析、方差分析以及简单和逐步回归。
52名婴儿符合纳入标准。舒张末期血流速度消失或反向的婴儿（n = 19）的有核红细胞计数显著高于舒张末期血流速度存在的婴儿（n = 33）（有核红细胞/100个有核细胞±标准差：135.5±138 vs 17.4±23.7，p < 0.0001）。这些婴儿循环中有核红细胞清除的时间间隔显著更长（p < 0.0001）。他们的出生体重也更低（p < 0.05），初始血小板计数更低（p = 0.0006），脐带血动脉血pH值更低（p < 0.05），脐带血碱缺失更高（p < 0.05），因“胎儿窘迫”行剖宫产的可能性增加（p < 0.05）。多变量分析表明，舒张末期血流速度消失或反向（p < 0.0001）和低出生体重（p < 0.0001）导致有核红细胞计数升高，而分娩时的孕周不是一个显著因素。
我们观察到孕周小于胎龄且脐动脉多普勒检查异常的胎儿有核红细胞计数显著升高，血小板计数降低。这可能表明产前血栓形成事件导致胎盘阻抗增加。胎儿对这种慢性状况的反应可能导致有核红细胞计数增加。
