Leukemoid Reaction and Preterm Birth: A Case Report of FIRS (Fetal Inflammatory Response Syndrome)

Abstract

This article describes a case of severe hyperleukocytosis in a preterm infant with fetal inflammatory response syndrome (FIRS) associated with funisitis of umbilical cord and intrauterine inflammation. FIRS is a cause of leukocytosis in newborn, as well as leukemoid reaction in 21 trisomy, congenital leukemia, sepsis, and steroid prophylaxis. Inflammatory response syndrome is associated with high mortality, developmental impairment and complications of prematurity like intraventricular hemorrhage, chronic lung disease, periventricular leukomalacia, and sepsis.

Infection Induced Fetal Inflammatory Response Syndrome (FIRS): State-of- the-Art and Medico-Legal Implications—A Narrative Review

“…The main sign of fetal distress is tachycardia, detectable via ultrasound [14,15]. Moreover, ultrasound measurement of thymus dimensions might constitute a reliable marker of FIRS [26].…”

“…Neonatal sepsis and CA lead to morphologic modifications and shrinkage of the thymus and spleen [25]. Lastly, in the context of histological CA, fetal dermatitis can be a clinical sign, characterized by infiltration of neutrophils, lymphocytes, and histiocytes [26].…”

“…Spontaneous intestinal perforation and necrotizing enterocolitis are more frequent in newborns with placental CA. Abnormal cortisol-to-dehydroepiandrosterone ratios and hematological alterations (neutrophilia, neutropenia, elevated nucleated red blood cell counts, and thrombocytopenia) have been reported in infants with FIRS [1,10,26].…”