ABSTRACT. Background. Leukemoid reaction (LR) is defined as an absolute neutrophil count (ANC) of >30 ؋ 10 3 /mm 3 . No previous study has systemically examined the clinical and prognostic significance of this phenomenon in extremely low birth weight (ELBW) infants.Objective. The purpose of this study was to examine the effect of LR in morbidity, mortality, and long-term developmental outcome in ELBW infants.Method. Infants with gestational age of <30 weeks and birth weight <1000 g were included in the study (n ؍ 152). The medical records were reviewed for the clinical characteristics and long-term developmental outcome of these infants. Serial complete blood cell count and ANC were calculated on day 1 and weekly thereafter until discharge. LR was defined as an ANC of >30 ؋ 10 3 /mm 3 .Results. LR was detected in 17% of the study infants (26 of 152). ANC increased postnatally in LR (n ؍ 26) and no-LR (n ؍ 126) infants during hospitalization, peaked in the second week of life (43 ؎ 3 vs 14 ؎ 1 ؋ 10 3 /mm 3 ), and remained significantly higher in LR infants during the first 5 weeks of life. LR occurred more frequently during the first 2 weeks of life and lasted for 3 ؎ 1 days. There was no significant difference between the LR and no-LR infants in gestational age, birth weight, delivery mode, gender, Apgar scores, or incidence of respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, and retinopathy of prematurity. LR infants required a significantly longer duration of ventilatory support (36 ؎ 4 vs 21 ؎ 2 days), longer duration of oxygen requirement (58 ؎ 6 vs 40 ؎ 3 days), and had a higher incidence of bronchopulmonary dysplasia (BPD) (54% vs 25%) compared with no-LR infants. Furthermore, the length of hospitalization was significantly longer in LR infants (69 ؎ 6 vs 54 ؎ 3 days). There was no significant difference between the groups in developmental outcome at 2 years of age including receptive/expressive language, fine/gross motor skills, and hearing. Incidence of abnormal neurodevelopment outcome was also similar between LR and no-LR infants.Conclusions. LR in ELBW infants is associated with a prolonged need for ventilatory and oxygen support, a higher incidence of BPD, and a tendency for lower mortality. The findings from our study suggest that LR is associated with conditions known to have an excess of proinflammatory cytokines. Additional prospective study is needed to understand the relationship between LR, proinflammatory cytokines, and development of BPD. Pediatrics 2005;116:e43-e51. URL: www.pediatrics.org/ cgi/doi/10.1542/peds.2004-1379; leukemoid reaction, absolute neutrophil count, extremely low birth weight infants, bronchopulmonary dysplasia.
Preterm birth and infants' admission to neonatal intensive care units (NICU) are associated with significant emotional and psychological stresses on mothers that interfere with normal mother-infant relationship. Maternal selfefficacy in parenting ability may predict long-term outcome of mother-infant relationship as well as neurodevelopmental and behavioral development of preterm infants. The Perceived Maternal Parenting Self-Efficacy (PMP S-E) tool was developed to measure self-efficacy in mothers of premature infants in the United Kingdom. The present study determined if maternal and neonatal characteristics could predict PMP S-E scores of mothers who were administered to in a mid-west community medical center NICU. Mothers whose infants were born less than 37 weeks gestational age and admitted to a level III neonatal intensive care unit participated. Participants completed the PMP S-E and demographic survey prior to discharge. A logistic regression analysis was conducted from PMP S-E scores involving 103 dyads using maternal education, race, breast feeding, maternal age, infant's gestational age, Apgar 5-minute score, birth weight, mode of delivery and time from birth to completion of PMP S-E questionnaire. Time to completion of survey and gestational age were the significant predictors of PMP S-E scores. The finding of this study concerning the utilization of the PMP S-E in a United States mid-west tertiary neonatal center suggest that interpretation of the score requires careful consideration of these two variables.
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