Peripheral leukocyte count and leukocyte indexes in healthy newborn term infants,☆☆

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Abstract

Purpose: This study was designed to determine normal values for the peripheral leukocyte count and leukocyte indexes in healthy term neonates at a specific time after birth. Methods: We prospectively enrolled 193 healthy term-gestation neonates with no identifiable perinatal risk factors for sepsis. At 4 hours of age a blood sample was collected by warmed heel stick. An automated Coulter complete blood cell count and a 100-cell manual differential leukocyte count were performed on each sample. The differential count was performed by a single hematopathologist unaware of the clinical status of each infant. Perinatal factors were identified by review of the mothers' and infants' hospital records. Results: The mean ratio of immature to total neutrophils was 0.16 (SD 0.10), and the 10% to 90% range was 0.05 to 0.27. The mean leukocyte count was 24.06 × 109/L (24,060/mm3), and the 10% to 90% range was 16.2 to 31.5 × 109/L (16,200 to 31,500/mm3). Neutropenia, <1.5 × 109/L (1500/mm3) segmented plus band form neutrophils, was not observed. Of all the perinatal factors studied, only the duration of stage 1 labor was found to be associated with significant elevations in the leukocyte and absolute neutrophil counts. Conclusions: Previously published normal ranges for leukocyte indexes in healthy newborn infants during the early neonatal period are too restrictive; reference standards should be broadened. (J PEDIATR 1994;125:603-6)

Section snippets

METHODS

One hundred ninety-three consecutive healthy term-gestation neonates born at Wilford Hall Medical Center were enrolled in the study during the months of February to July 1993. A healthy neonate was defined as one without maternal, intrapartum, or neonatal complications that would give rise to the clinical suspicion of sepsis. Exclusion criteria included neonates born at less than 36 weeks of gestation, admission to the neonatal intensive care unit, proven sepsis or congenital pneumonia,

RESULTS

Table II lists the mean (±SD) and the 10% to 90% range for the leukocyte indexes in our population of healthy neonates at 4 hours of age. Though we report a 10% lower limit for the I/T and I/M ratios and the total immature forms, we recognize that a value of zero is also normal. Neutropenia, <1.5 × 109/L (1500/mm3) segmented and band neutrophils, was not present in any study patient.

Birth weight, sex, ethnicity, gestational age, maternal complications, intrapartum complications, umbilical

DISCUSSION

Numerous reports have suggested that neutrophil indexes, particularly the I/T ratio and the absolute neutrophil count, are useful predictors of sepsis in neonates.1, 2, 3, 4, 5, 6, 7, 8, 9, 10 The most comprehensive study was published in 1979 by Manroe et al.,9 who examined 585 peripheral smears from 304 neonates during the first 28 days of life to establish reference values for neutrophilic cells. The maximum normal I/T proportion found in that study was 0.16, but a relatively small number of

References (14)

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From the Departments of Pediatrics and Pathology, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas

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Reprint requests: Robert L. Schelonka, MD, Department of Pediatrics, Wilford Hall Medical Center/PSP, 2200 Bergquist Dr. STE 1, Lackland AFB, TX 78236-5300.

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