Total leukocyte and neutrophil count changes associated with antenatal betamethasone administration in premature infants

Abstract

The white blood cell counts of 84 premature infants were included in a retrospective study of 45 infants treated antenatally with betamethasone and 39 non-treated infants. A significant increase in neutrophil and immature neutrophil forms was found in the treated group when the drug was administered to the mother close to delivery. This effect lasted for three days. Afterwards, although the counts were not significantly high compared to the control group, their physiological decrease was delayed. This study indicates that the known stimulating effect of steroids on total leukocyte and neutrophil counts in adult humans and fetal lambs, also occurs in premature infants. This fact supports recent reports which propose the antenatal maternal administration of betamethasone as a cause of leukemoid reaction or leukocytosis after birth.

Association of BPD and IVH with early neutrophil and white counts in VLBW neonates with gestational age <32 weeks

“…This is consistent with other studies of factors influencing WBC and neutrophil counts. [5][6][7]9 Previous studies of the association between neutrophil count and neonatal outcomes have tended to exclude births following pregnancy complications suspected to affect differential blood counts. 4 Interestingly, associations between low neutrophil count, BPD and IVH in this study that excluded key pregnancy complications and infants exposed to antenatal steroids were similar to ours.…”

“…However, we did not find race to be a major factor influencing the counts. Antenatal steroids are well known to have a stimulating effect on leukocyte and neutrophil counts 7 by enhancing the release of neutrophil and decreasing their clearance from the circulation. 22 Consistent with this, we found that neutrophil counts were affected by exposure to antenatal steroid therapy.…”

“…4 The previous human study 4 excluded neonates born following certain maternal complications and treatments such as pregnancy-induced hypertension and antenatal steroid therapy that are associated with inhibition or enhancement of neutrophil counts. [5][6][7][8][9] These exclusions limit the applicability of the findings, especially as antenatal steroid therapy is now almost ubiquitous. In addition, the neutrophil count in the above studies was mapped by sampling cord and/or early blood in well-controlled or single hospital settings.…”

Outcome of Extremely Low Birth Weight Infants With Leukemoid Reaction

“…[10][11][12] Neonatal LR has been described in a number of case reports in association with various clinical conditions including prematurity, chromosomal anomalies, exposure to antenatal corticosteroids (ANS), severe anemia, infections, and bronchopulmonary dysplasia (BPD). 8,9,[13][14][15][16][17][18][19][20] In the recent clinical studies by Calhoun et al 10 and Rastogi et al, 21 LR occurred in 1.3% to 15% of infants admitted to neonatal intensive care units, with no significant association demonstrated between LR and maternal and neonatal variables. In addition, Zanardo et al, 20 in a retrospective case-controlled study of preterm infants with gesta-tional age of Ͻ32 weeks, showed that BPD was associated with higher incidence of LR (5 of 50 vs 0 of 50; P ϭ .001).…”

Hyperleukocytosis in a premature infant with intrauterine herpes simplex encephalitis

“…This mother received antenatal steroids that have been proposed as being associated with leukemoid reactions, however, this possible association has not been confirmed in subsequent case series and mechanistic studies. 6,8,12 Given the initial elevation of the maternal WBC count and the microscopic analysis of the placenta, bacterial chorioamnionitis is a possible cause of the infant's high WBC count; however, all bacterial cultures were negative and there were no toxic granulations or vacuolization noted on the infant's peripheral blood smear. Chromosomal analysis was performed to rule out the possibility of leukemoid reaction related to mosaic trisomy 21 (result: 46XX).…”