Objective-To test the hypothesis that inflammation modulates fetal erythroblastosis and/or the release of NRBCs independent of hypoxia or fetal stress. We sought to determine if fetal inflammation is associated with an elevation in neonatal NRBC count in the setting of inflammation-associated preterm birth.Study Design-The relationships between peripheral NRBC count, histological chorioamnionitis, umbilical cord interleukin-6 (IL-6), erythropoietin (EPO), cortisol and acid-base status were analyzed in 68 preterm singletons, born to mothers who had an amniocentesis to rule out infection. Proteomic profiling of amniotic fluid identified presence of intra-amniotic inflammation according to established parameters. NRBC counts were assessed within 1-hour of birth. Early-onset neonatal sepsis (EONS) was established based on hematological and microbiological indices. IL-6, EPO and cortisol levels were measured by immunoassays. Fetal acid-base status was determined within 10 minutes of delivery. Parametric or nonparametric statistics was employed.Results-Fetuses with EONS (n=19) were delivered at earlier gestational ages (mean±SD: 27.1±2.8 weeks, P=0.001) and more often by mothers with intra-amniotic inflammation (P=0.022) and histological chorioamnionitis (P<0.001). Neonates with EONS had higher absolute NRBCs
Condensation:In inflammation-associated preterm birth and in the absence of hypoxia, elevated neonatal nucleated red blood cell counts may be a direct response to inflammatory mediators.
Authors' Contributions:Antonette Dulay is the principal investigator and responsible author. Antonette Dulay, Irina Buhimschi and Catalin Buhimschi designed the study, generated, interpreted the data and wrote the initial draft of the manuscript. Guomao Zhao participated with processing of biological samples, performed immunoassays, revised critically the manuscript and approved the final version. Vineet Bhandari participated with aspects of data analysis and interpretation, revised critically the manuscript and approved the final version. Guoyang Luo; Sonya Abdel-Razeq; Michael Cackovic, Victor Rosenberg, Christian Pettker Stephen Thung and Mert Ozan Bahtiyar participated with patient enrollment, acquisition of demographic and clinical data, critical revision of the manuscript and approved the final version.
NIH Public AccessAuthor Manuscript Am J Obstet Gynecol. Author manuscript; available in PMC 2014 May 16. Published in final edited form as: Am J Obstet Gynecol. 2008 April ; 198(4): 426.e1-426.e9. doi:10.1016/j.ajog.2008 NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript counts (P=0.011). NRBC counts were directly correlated with cord blood IL-6 levels (P<0.001) but not with EPO, cortisol or parameters of acid-base status levels regardless of EONS status. These relationships remained following correction for gestational age, diabetes, intrauterine growth restriction (IUGR) and steroid exposure.Conclusion-In the setting of inflammation-associated preterm birth and in the absence of hypoxia,...