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

Journal of Perinatology volume 29, pages 822–825 (2009)Cite this article

Abstract

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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References

  1. Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A . Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC. MMWR Recomm Rep 2002; 51 (RR-11): 1–22.

    PubMed  Google Scholar 

  2. Pickering LK Misc:(ed) Red Book, 2006 Report of the Committee on Infectious Diseases. 27th edn. American Academy of Pediatrics: Elk Grove Village, IL.pp 620–627.

  3. Manroe BL, Weinberg AG, Rosenfeld CR, Browne R . The neonatal blood count in health and disease. I. Reference values for neutrophilic cell. J Pediatr 1979; 95: 89–98.

    Article  CAS  Google Scholar 

  4. Carballo C, Foucar K, Swanson P, Papile LA, Watterberg KL . Effect of high altitude on neutrophil counts in newborn infants. J Pediatr 1991; 119: 464–466.

    Article  CAS  Google Scholar 

  5. Maynard EC, Reed C, Kircher T . Neutrophil counts in newborn infants at high altitude. J Pediatr 1993; 122: 990–991.

    Article  CAS  Google Scholar 

  6. Schmutz N, Henry E, Jopling J, Christensen RD . Expected ranges for blood neutrophil concentrations of neonates: the Manroe and Mouzinho charts revisited. J Perinatol 2008; 28: 275–281.

    Article  CAS  Google Scholar 

  7. Christensen RD, Rothstein G, Hill HR, Hall RT . Fatal early onset group B streptococcal sepsis with normal leukocyte counts. Pediatr Infect Dis J 1985; 4 (3): 242–245.

    Article  CAS  Google Scholar 

  8. Greenberg DN, Yoder BA . Changes in the differential white blood cell count in screening for group B streptococcal sepsis. Pediatr Infect Dis J 1990; 9 (12): 886–889.

    Article  CAS  Google Scholar 

  9. Schelonka RL, Yoder BA, desJardins SE, Hall RB, Butler J . Peripheral leukocyte count and leukocyte indexes in healthy newborn term infants. J Pediatr 1994; 125 (4): 603–606.

    Article  CAS  Google Scholar 

  10. Ottolini MC, Lundgren K, Mirkinson LJ, Cason S, Ottolini MG . Utility of complete blood count and blood culture screening to diagnose neonatal sepsis in the asymptomatic at risk newborn. Pediatr Infect Dis J 2003; 22 (5): 430–434.

    PubMed  Google Scholar 

  11. Christensen RD, Henry E, Wiedmeier SE, Stoddard RA, Lambert DK . Low blood neutrophil concentrations among extremely low birth weight neonates: data from a multihospital health-care system. J Perinatol 2006; 26 (11): 682–687.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Intermountain Healthcare, Ogden, UT, USA

    R M Lambert, V L Baer, S E Wiedmeier, E Henry, J Burnett & R D Christensen

  2. McKay-Dee Hospital Center, Ogden, UT, USA

    R M Lambert, V L Baer & R D Christensen

  3. Intermountain Medical Center, Murray, UT, USA

    S E Wiedmeier & J Burnett

  4. The Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA

    S E Wiedmeier

  5. The Institute for Healthcare Delivery Research, Salt Lake City, UT, USA

    E Henry

Authors
  1. R M Lambert
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  2. V L Baer
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  3. S E Wiedmeier
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  4. E Henry
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  5. J Burnett
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  6. R D Christensen
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Correspondence to R D Christensen.

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Lambert, R., Baer, V., Wiedmeier, S. et al. Isolated elevated blood neutrophil concentration at altitude does not require NICU admission if appropriate reference ranges are used. J Perinatol 29, 822–825 (2009). https://doi.org/10.1038/jp.2009.3

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