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Am J Perinatol 2022; 39(16): 1792-1795
DOI: 10.1055/s-0041-1726317
Original Article

Nucleated Red Blood Cells as Markers of Perinatal Adaptation in Preterm Neonates Receiving Minimally Invasive Surfactant Therapy

Itamar Nitzan
1   Monash Newborn, Monash Children's Hospital, Melbourne, Australia
,
Calum T. Roberts
1   Monash Newborn, Monash Children's Hospital, Melbourne, Australia
2   Department of Paediatrics, Monash University, Melbourne, Australia
,
Risha Bhatia
1   Monash Newborn, Monash Children's Hospital, Melbourne, Australia
2   Department of Paediatrics, Monash University, Melbourne, Australia
,
Francis B. Mimouni
3   Department of Neonatalogy, Shaare Zedek Medical Center, Jerusalem, Israel
4   Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
,
Arvind Sehgal
1   Monash Newborn, Monash Children's Hospital, Melbourne, Australia
2   Department of Paediatrics, Monash University, Melbourne, Australia
› Author Affiliations Funding None.
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Abstract

Objective The study aimed to assess the association of nucleated red blood cells (NRBC), a surrogate of intrauterine hypoxia, and elevated pulmonic vascular resistance (E-PVR) and oxygen requirement after minimally invasive surfactant therapy (MIST).

Study Design Retrospective study of a cohort of preterm neonates that received MIST in a single unit.

Results NRBC were measured in 65 of 75 (87%) neonates administered MIST during the period. In total, 22 of 65 (34%) infants had pre-MIST echocardiography (ECHO).

Neonates with elevated NRBC (predefined as >5 × 109/L, n = 16) required higher post-MIST fraction of inspired oxygen (FiO2) than neonates with normal NRBC (<1 × 109/L, n = 17; FiO2 = 0.31 ± 0.10 and 0.24 ± 0.04, respectively, p = 0.02).

NRBC correlated positively with % of time in right to left ductal shunt (r = 0.51, p = 0.052) and inversely with right ventricular stroke volume (r = −0.55, p = 0.031) and time to peak velocity to right ventricular ejection time ratio (r = −0.62, p < 0.001).

Conclusion Elevated NRBC are associated with elevated FiO2 after MIST and elevated E-PVR. Intrauterine hypoxia may impact postnatal circulatory adaptations and oxygen requirement.

Key Points

  • Post-MIST FiO2 requirements are significantly higher in infants with elevated NRBC.

  • NRBC correlates positively with elevated PVR in neonates requiring.

  • Intrauterine hypoxia may play a role in postnatal circulatory adaptations in neonates with RDS.

Keywords

Respiratory Distress Syndrome - persistent pulmonary hypertension - pulmonary vascular resistance - functional echocardiography - erythropoietin

Note

Abstract containing some of the study information was accepted to the PSANZ conference in Sydney 2020.




Publication History

Received: 05 August 2020

Accepted: 01 February 2021

Article published online:
23 March 2021

© 2021. Thieme. All rights reserved.

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