Relationship Between Neonatal Leukemoid Reaction and Bronchopulmonary Dysplasia in Low-Birth-Weight Infants: A Cross-Sectional Study

Zanardo, Vincenzo; Savio, Valentina; Giacomin, Carlo; Rinaldi, Andrea; Marzari, F.; Chiarelli, Silvia

doi:10.1055/s-2002-35612

Cited by 20 publications

(24 citation statements)

References 20 publications

(40 reference statements)

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“…Our study provides further support to the findings of previous research showing an association between elevated WBC and BPD 14,16 in premature infants exposed, and unexposed, to histological chorioamnionitis. Hsiao and Omar 16 showed an increased risk of BPD with total WBC >30 000 per mm 3 , in infants of 1000 g birth weight.…”

Section: Discussionsupporting

confidence: 91%

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Reduced mortality and increased BPD with histological chorioamnionitis and leukocytosis in very-low-birth-weight infants

et al. 2009

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Objective: To investigate the association between leukocytosis, mortality and bronchopulmonary dysplasia (BPD) in very-low-birth-weight infants (VLBW) born to mothers with histological chorioamnionitis.Study Design: A retrospective cohort study from a single level 3 neonatal intensive care unit. The study sample included infants born to mothers with histological chorioamnionitis (n ¼ 252). Total white blood cells (WBCs) after birth were measured. Leukocytosis was defined as a total WBC count >30 000 per mm 3 in the first 2 days of life. Outcomes investigated included BPD and death. Both unadjusted and multivariable analyses were carried out.Result: After controlling for potential confounding variables, infants who developed a leukocytosis after birth had increased odds of BPD (4.6, 95% confidence interval (95% CI): 2.0 to 10.3), but decreased odds of death (0.3, 95% CI: 0.1 to 0.90). Conclusion:In our population of VLBW infants born to mothers with histological chorioamnionitis, leukocytosis after birth is associated with a decrease in mortality but an increase in BPD.

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Section: Discussionsupporting

confidence: 91%

“…Our data support other research, indicating an association between BPD and leukocytosis in preterm infants. [14][15][16] To our knowledge, this is the first study limited to infants exposed to histological chorioamnionitis, and is the first report of an increase in survival with an associated leukocytosis.…”

Section: Discussionmentioning

confidence: 82%

Reduced mortality and increased BPD with histological chorioamnionitis and leukocytosis in very-low-birth-weight infants

et al. 2009

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“…The terms leukocytosis or leukemoid reaction have been used to describe an abnormally elevated white blood cell (WBC) count. Hill and Duncan 1 used a threshold of WBC count >50 000 to define leukocytosis, whereas Zanardo et al 2 used a cutoff of 40 000. Others used absolute neutrophil count values for defining pathology, for example, a count of >10 standard deviations above the mean for a given gestational age or an absolute neutrophil count of >30 000 during the first week after birth for diagnosing neutrophilia.…”

Section: Introductionmentioning

confidence: 99%

“…7,16 An association between fetal inflammatory response syndrome and neonatal morbidities, especially chronic lung disease has been reported in small case series and case-control studies. 2,7,13 However, its association with other neonatal morbidities is not known.…”

Section: Introductionmentioning

confidence: 99%

Leukocytosis in very low birth weight neonates: associated clinical factors and neonatal outcomes

et al. 2008

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Objective: Primary objective was to identify clinical factors and outcomes associated with leukocytosis in very low birth weight (VLBW) neonates. Secondary objective was to compare outcomes between infants with earlyonset (p72 h of age) and late-onset leukocytosis (>72 h).Study Design: A retrospective matched cohort study of VLBW neonates born at p30 weeks of gestation identified with a white blood cell count of X40 000 was undertaken. Matched infants had no leukocytosis and were of similar gestational age. Data on common neonatal morbidities were collected from charts.Result: Leukocytosis was identified in 96 infants giving an incidence rate of 6.1%. Of all, 94 matched infants without leukocytosis were identified. There were no differences in the demographic features and risk factors between the two groups. The incidence of confirmed infection among infants with leukocytosis was 22%. No differences in common neonatal morbidities and mortality were identified between two groups. Late-onset leukocytosis (X72 h of age) was associated with sepsis and necrotizing enterocolitis. No differences in any of the other outcomes between earlyonset and late-onset leukocytosis were identified.Conclusion: Leukocytosis, especially late onset, was associated with infection in VLBW infants. Late-onset leukocytosis was also associated with necrotizing enterocolitis indicating that postnatal age at time of leukocytosis should be considered when formulating clinical decisions.

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“…[10][11][12] Neonatal LR has been described in a number of case reports in association with various clinical conditions including prematurity, chromosomal anomalies, exposure to antenatal corticosteroids (ANS), severe anemia, infections, and bronchopulmonary dysplasia (BPD). 8,9,[13][14][15][16][17][18][19][20] In the recent clinical studies by Calhoun et al 10 and Rastogi et al, 21 LR occurred in 1.3% to 15% of infants admitted to neonatal intensive care units, with no significant association demonstrated between LR and maternal and neonatal variables. In addition, Zanardo et al, 20 in a retrospective case-controlled study of preterm infants with gesta-tional age of Ͻ32 weeks, showed that BPD was associated with higher incidence of LR (5 of 50 vs 0 of 50; P ϭ .001).…”

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confidence: 99%

Outcome of Extremely Low Birth Weight Infants With Leukemoid Reaction

Hsiao¹

2005

Pediatrics

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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.

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Relationship Between Neonatal Leukemoid Reaction and Bronchopulmonary Dysplasia in Low-Birth-Weight Infants: A Cross-Sectional Study

Cited by 20 publications

References 20 publications

Reduced mortality and increased BPD with histological chorioamnionitis and leukocytosis in very-low-birth-weight infants

Reduced mortality and increased BPD with histological chorioamnionitis and leukocytosis in very-low-birth-weight infants

Leukocytosis in very low birth weight neonates: associated clinical factors and neonatal outcomes

Outcome of Extremely Low Birth Weight Infants With Leukemoid Reaction

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