Neutrophil counts in newborn infants at high altitude

Maynard, Edward C.; Reed, Chuck; Kircher, Tobias

doi:10.1016/s0022-3476(09)90037-3

Cited by 16 publications

(9 citation statements)

References 5 publications

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“…However, the exact mechanistic explanation for this finding is not known. We suspect that altitude was indeed the main difference between the present range of neutrophil and that reported by Manroe 1 and Mouzinho, 2 because the Carballo 15 and Maynard 16 reports used the older methods, yet our ranges are similar to theirs. …”

Section: Discussionsupporting

confidence: 47%

“…Dallas is 500 feet above sea level and the Intermountain Healthcare hospitals are at an average of 4800 feet above sea level. Carballo et al, 15 Maynard et al 16 and Manroe 17 reported that high-altitude results in higher blood neutrophil concentrations of newborn infants. They speculated that reduced oxygen delivery to the fetus is involved in the mechanism.…”

Section: Discussionmentioning

confidence: 99%

“…3 On that basis, we judge that efforts to refine the interpretability of CBCs from neonatal intensive care unit patients are worthwhile, 24 and we maintain that our present update of the landmark papers of the Dallas group is a useful step in that direction. The publications by Carballo et al 15 and Maynard et al 16 recommended that neonatal centers at high Upper limit at delivery (ml À1 ) Lower limit at delivery (ml À1 )…”

Section: Neutrophil Counts Of Neonates N Schmutz Et Almentioning

confidence: 99%

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Expected ranges for blood neutrophil concentrations of neonates: the Manroe and Mouzinho charts revisited

et al. 2008

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Section: Discussionsupporting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Neutrophil Counts Of Neonates N Schmutz Et Almentioning

confidence: 99%

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Expected ranges for blood neutrophil concentrations of neonates: the Manroe and Mouzinho charts revisited

et al. 2008

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“…In the interval between 72 and 240 h after birth, the ANC ranged between 2700 and 13 000/ml (5-95th percentile) for infants born above 36 weeks' gestation, between 1000 and 12 500/ml at 28-36 weeks, and 1300 and 15 300/ml at less than 28 weeks' gestation. The upper limits of ANC in this study were higher than those in the ranges reported in the studies by Manroe et al [10] and Mouzinho et al [9], possibly an effect of the high altitude at which the participating centers were located [15][16][17].…”

Section: Normal Blood Neutrophil Concentrations In Neonatescontrasting

confidence: 76%

Neutropenia in the newborn

Maheshwari¹

2013

Current Opinion in Hematology

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“…Studies by Carballo et al 4 in New Mexico and Maynard et al 5 in Colorado suggest that during the days after birth, neonates born at a high altitude have considerably higher blood neutrophil counts than do those born at sea level. We recently documented this observation by examining a large sample size (>30 000) of neonates at Intermountain Healthcare, and found that the reference range for ANC in the initial days after birth was indeed more than double that obtained on the Manroe chart.…”

Section: Introductionmentioning

confidence: 94%

Isolated elevated blood neutrophil concentration at altitude does not require NICU admission if appropriate reference ranges are used

et al. 2009

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Objective: The Intermountain Healthcare hospitals use a clinical pathway algorithm for early-onset infection, which is based on the 2002 Centers for Disease Control and Prevention (CDC) guidelines for perinatal group B streptococcal disease. As part of this pathway, neonates in the well baby nursery, who seem to be well but have risk factors for infection, receive a 'limited laboratory evaluation including a CBC', and if the complete blood cell count (CBC) is abnormal, antibiotic treatment and neonatal intensive care unit (NICU) monitoring are initiated. We recently found that reference ranges for absolute neutrophil counts (ANCs) are much wider at our altitude (4800 to 5000 ft) than at sea level. On this basis, we speculated that some well babies with risk factors for infection are mistakenly judged as having an abnormal CBC, and are unnecessarily admitted to the NICU .Study Design: This was a retrospective observational cohort study of neonates of >37 weeks gestation admitted to either of two Intermountain Healthcare NICUs for intravenous antibiotic treatment during a recent 36-month period.Results: During the study period 3217 patients were admitted to the two NICUs, 1049 (32.6%) of which were born at>37 weeks gestation. Of these, 14 (1.3%) were found to have been admitted to the NICU on the basis of an abnormal CBC (elevated ANC), when in retrospect, using the appropriate ANC chart, their CBCs were completely normal. None of the 14 neonates had a leukocyte left shift (immature to total neutrophil ratio >0.3) or thrombocytopenia. None were treated with supplemental oxygen or mechanical ventilation in the NICU. All 14 had sterile blood cultures. All had antibiotics stopped in 48 to 72 h, and all were discharged home as well babies. Conclusion:We identified 14 neonates who, while in the well baby nursery, were found to have risk factors for early-onset infection, but did not seem to be infected, and were subsequently admitted to a NICU for intravenous antibiotic treatment and monitoring under the mistaken impression that they had an abnormal CBC. We maintain that use of an appropriate neutrophil reference range chart can reduce NICU admissions and can limit unnecessary antibiotic exposure.

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Neutrophil counts in newborn infants at high altitude

Cited by 16 publications

References 5 publications

Expected ranges for blood neutrophil concentrations of neonates: the Manroe and Mouzinho charts revisited

Expected ranges for blood neutrophil concentrations of neonates: the Manroe and Mouzinho charts revisited

Neutropenia in the newborn

Isolated elevated blood neutrophil concentration at altitude does not require NICU admission if appropriate reference ranges are used

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