Neonatal neutrpenia associated with pregnancy induced hypertension and cord blood granulocyte colony stimulating factor

ABSTRACT

Neutropenia is frequently observed in neonates born to mothers with pregnancy induced hypertension [PIH]. Though transient, it may be a leading cause of early neonatal sepsis. Hence, prophylactic exogenous hematopoietic factors are currently tried. However. Causes of this neonatal neutronenia [NN] and its relation to the endogenous production of these factors are still obscure, therefore we aimed to study granulocyte colony stimulating factor [G-CSF] among other determinants of NN in this population. The present study included 92 neonates; 52 born to normotensive mothers and 40 neonates with maternal PIH. Gestational age [GA] and birth weight [BW] were assessed with clinical evaluation of all studied neonates at birth and after 72 hours to rule out infection. Cord blood absolute neutrophil count [ANC] and levels Of G-CSF [as measured by ELISA] were studied. Neonates born to mothers with PIH had significantly [P<0.05] lower ANC than control newborns. ANC was significantly [P<0.01] lower in neonates with GA <32 weeks as compared to those >32 weeks. Values of ANC were significantly positively correlated with BW [P<0.05]. Neonatal neutropenia [ANC <1.5 x 10[9]/ L] was observed in 35% of infants born to mothers with PIH being moderate to severe [ANC< 1x10[9] / L] in 25%. Of these neonates with moderate to severe NN, 90% were of low BW and 60% were preterms of GA less than 32 weeks. Mean value of cord blood G-CSF [126.3 +/- 99.6 pg/L] was significantly [P<0.001] lower in all babies of mothers with PIH than control [283.9 +/- 221.7 pg/L]. A significant positive correlation was noted between ANC and G-CSF [P<0.05] in FT neonates. Neonates whose GA<32 weeks showed significantly increased frequency of moderate to severe neutropenia [66.7%] compared to other GA groups [13.3% and 12.5% in those born after 37 weeks and those born between 33 and 36 weeks, respectively] [p<0.05]. The least reported mean cord blood G-CSF in this study [79.3 +/- 31.14 pg /L] was encountered in neonates whose GA<32 weeks and who exhibited NN that approached severity [mean ANC 0.59 +/- 0.21 x 10 [9]/L]. Early neutropenia may be noted in neonates born to mothers with PIH. It may be related to reduced serum G-CSF especially in LBW and in those with increased degree of prematurity. This population may be suitable c and idates for recombinant human G-CSF [rh G-CSF] therapy