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Recent evidences suggest that red cell distribution width (RDW) can be a good prognostic marker for adverse outcomes in adult cardiovascular disease. This association has been attributed to the impaired erythropoiesis and abnormal red blood cell survival, originating from chronic hypoxic status or poor nutritional condition. Considering the pathophysiologic association between fetal growth restriction and chronic intrauterine hypoxia, which in turn can result in impaired erythropoiesis, we hypothesized that RDW could be a novel biomarker in fetal growth restriction. To address this issue, we evaluated the RDW in fetal growth restriction.
The study population consisted of singleton preterm neonates (24-34 weeks of gestation) born in Seoul National University Hospital. RDW in cord blood was measured at the time of delivery, and was compared between small for gestational age (SGA) neonates (birthweight < 10 percentile) and non-SGA neonates (birthweight ≥ 10 percentile). Among SGA neonates, RDW was also examined according to the presence or absence of neonatal morbidity and/or mortality.
A total of 552 neonates were included in the analysis, including 115 SGA neonates and 437 non-SGA neonates. RDW of SGA neonates was significantly higher than that of non-SGA neonates (median, 18.9 in SGA neonates vs. 16.6 in non-SGA neonates, p<0.001). In SGA neonates, RDW increased as the umbilical arterial Doppler worsened. In addition, RDS above 90 percentile was associated with increased neonatal morbidity and/or mortality among SGA neonates, and this relationship remained statistically significant after adjustment for gestational age at delivery, birthweight, and hematologic parameters.
The RDW was higher in SGA neonates and was associated with neonatal morbidity and/or mortality among SGA neonates.