Correlation of neonatal nucleated red blood cell counts in preterm infants with histologic chorioamnionitis


      OBJECTIVE: The aim of this study was to compare the neonatal nucleated red blood cell counts in preterm infants in the presence and absence of clinical and histologic chorioamnionitis while controlling for gestational age and birth weight percentile. STUDY DESIGN: Nucleated red blood cell counts were obtained from preterm infants delivered after preterm labor or preterm premature rupture of membranes. Patients were divided on the basis of clinical and histologic chorioamnionitis. Nucleated red blood cell counts between groups were compared, and regression analysis controlling for gestational age and birth weight percentile was performed. RESULTS: Of 359 patients, both measures of infection status were significantly associated with increased nucleated red blood cell counts. In the regression analysis histologic chorioamnionitis retained significance, whereas clinical chorioamnionitis did not. CONCLUSIONS: Histologic chorioamnionitis produces an erythropoietic response in the fetus. Whether fetal erythropoiesis is a direct response to mediators of inflammation or whether it is the result of a rise in erythropoietin is unknown.(Am J Obstet Gynecol 1997;177:27-30.)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Phelan JP
        • Ahn MO
        • Korst L
        • Martin GI.
        Nucleated red blood cells: a marker for fetal asphyxia.
        Am J Obstet Gynecol. 1994; 170 ([abstract]): 286
        • Philip GS
        • Tito AM.
        Nucleated red blood cell counts in small for gestational age infants with very low birthweight.
        Arch Pediatr Adolesc Med. 1989; 143: 164-169
        • Soothill PW
        • Nicolaides KH
        • Campbell S.
        Prenatal asphyxia, hyperlactiaemia, hypoglycemia and erythroblastosis in growth retarded fetuses.
        BMJ. 1987; 294: 1051-1053
        • Green DW
        • Mimouni F.
        Nucleated erythrocytes in healthy infants and in infants of diabetic mothers.
        J Pediatr. 1989; 116: 129-131
        • Nicolini U
        • Nicolaidis P
        • Fisk NM
        • Vaughan JI
        • Fusi L
        • Gleason R
        • et al.
        Limited role of fetal blood sampling in prediction of outcome in intrauterine growth retardation.
        Lancet. 1990; 336: 768-772
        • Maier RF
        • Gunther A
        • Vogel M
        • Dudenhausen JW
        • Obladen M.
        Umbilical venous erythropoietin and umbilical arterial pH in relation to morphologic placental abnormalities.
        Obstet Gynecol. 1994; 84: 81-87
        • Teramo KA
        • Widness JA
        • Clemons GK
        • Voutilainen P
        • McKinlay S
        • Schwartz R
        Amniotic fluid erythropoietin correlates with umbilical plasma erythropoietin in normal and abnormal pregnancy.
        Obstet Gynecol. 1987; 69: 710-716
        • Cotes PM
        • Canning CE.
        Changes in serum immunoreactive erythropoietin during the menstrual cycle and normal pregnancy.
        Br  J Obstet Gynaecol. 1983; 90: 304-311
        • Thomas RM
        • Canning CE
        • Cotes PM
        • Linch DC
        • Rodeck CH
        • Rossiter CE
        • et al.
        Erythropoietin and cord blood haemoglobin in the regulation of human fetal erythropoiesis.
        Br J Obstet Gynaecol. 1983; 90: 795-800
        • Rollins MD
        • Maxwell AP
        • Afrasiabi M
        • Halliday HL
        • Lappin TRJ.
        Cord blood erythropoietin, pH, PaO2 and hematocrit following caesarean section and before labour.
        Biol Neonate. 1993; 63: 147-152
        • Widness JA
        • Sawyer ST
        • Schmidt RL
        • Chestnut DH.
        Lack of maternal to fetal transfer of 125I-labelled erythropoietin in sheep.
        J Dev Physiol. 1991; 15: 139-143
        • Maier RF
        • Bohme K
        • Dudenhausen JW
        • Obladen M.
        Cord blood erythropoietin in relation to different markers of fetal hypoxia.
        Obstet Gynecol. 1993; 81: 575-580
        • Cole RJ
        • Paul J.
        The effects of erythropoietin on haem synthesis in mouse yolk sac and cultured fetal cells.
        J Embryol Exp Morphol. 1966; 15: 245-260
        • Ruth V
        • Fyhrquist F
        • Clemons G
        • Raivio KO.
        Cord plasma vasopressin, erythropoietin, and hypoxanthine as indices of asphyxia at birth.
        Pediatr Res. 1988; 24: 490-494
        • Eckhard K-U
        • Hadmann W
        • Vetter J
        • Pohlandt F
        • Burghardt R
        • Kurtz A.
        Serum immunoreactive erythropoietin of children in health and disease.
        Eur J Pediatr. 1990; 149: 459-464
        • Clemons GK
        • Fitzsimmons SL
        • De Manincor D.
        Immunoreactive erythropoietin concentrations in fetal and neonatal rats and the effects of hypoxia.
        Blood. 1986; 68: 892-899
        • Widness JA
        • Teramo KA
        • Clemons GK
        • Garcia JF
        • Cavalieri RL
        • Piasecki GJ
        • et al.
        Temporal response of immunoreactive erythropoietin to acute hypoxemia in fetal sheep.
        Pediatr Res. 1986; 20: 15-19
        • Salafia CM
        • Minior VK
        • Pezzullo JC
        • Ghidini A
        • Ernst LM
        • Sherer DM.
        In premature rupture of membranes and preterm labor neonatal nucleated erythrocyte number (nRBCs) is related to histologic acute inflammation and not to placental markers of hypoxia.
        Am J Obstet Gynecol. 1996; 174 ([abstract]): 318
        • Dubowitz LMS
        • Dubowitz V
        • Goldberg CG.
        Clinical assessment of the newborn infant.
        J Pediatr. 1970; 77: 1
        • Brenner WE
        • Edelman DA
        • Hendricks CH.
        A standard of fetal growth for the United States of America.
        Am J Obstet Gynecol. 1976; 126: 555-564
        • Netter J
        • Wasserman W
        • Kutner MH.
        Applied linear statistical models.
        3rd ed. Irwin, Boston1990
        • Mayani H
        • Little MT
        • Dragowska W
        • Thornbury G
        • Lansdorp PM.
        Differential effects of the hematopoietic inhibitors MIP-1alpha, TGF-beta, and TNF-alpha on cytokine-induced proliferation of subpopulations of CD34+ cells purified from cord blood and fetal liver.
        Exp Hematol. 1995; 23: 422-427
        • Moore MAS.
        Clinical implications of positive and negative hematopoietic stem cell regulators.
        Blood. 1991; 78: 1-19