Original Article

Journal of Perinatology (2005) 25, 320–324. doi:10.1038/sj.jp.7211287 Published online 18 March 2005

Thrombopoietin Level Is Increased in the Serum of Asphyxiated Neonates: A Prospective Controlled Study

Hany Aly MD1, Amal El Beshlawy MD2, Nadia Badrawi MD2, Lamiaa Mohsen MD2, Eman Mansour MD3, Nermin Ramy MD2 and Kantilal Patel PhD4

  1. 1Newborn Services (H.A.), The George Washington University Hospital, Washington, DC, USA
  2. 2Pediatrics (A.E.B., N.B., L.M., N.R.), Cairo University School of Medicine, Cairo, Egypt
  3. 3Clinical Pathology (E.M.), Cairo University School of Medicine, Cairo, Egypt
  4. 4Biostatistics (K.P.), The Children's National Medical Center, Washington, DC, USA

Correspondence: Hany Aly, MD, Department of Newborn Services, The George Washington University Hospital, 900 23rd Street, NW #G2092, Washington, DC 20037, USA. E-mail: haly@mfa.gwu.edu

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Abstract

BACKGROUND:

 

Thrombopoietin (TPO) is a growth factor that controls platelet production. Despite the known association of chronic hypoxia and acute asphyxia with hematologic changes, TPO had not been studied in neonatal asphyxia.

OBJECTIVE:

 

To assess TPO concentrations in the serum of asphyxiated and nonasphyxiated neonates, and examine any correlation with the severity of asphyxia.

DESIGN/METHODS:

 

This prospective study was carried out on 32 asphyxiated neonates and 30 control subjects admitted at Cairo University Medical Center. Asphyxia was defined if two of the following were found: (1) Apgar score less than or equal to3 at 1 minute or less than or equal to6 at 5 minutes, (2) umbilical cord arterial pH less than or equal to7.2 combined with base deficit greater than or equal to-10 and (3) clinical evidence of perinatal asphyxia. Encephalopathy was classified clinically according to Sarnat's stages during the first day of life. Platelet count and TPO level (pg/ml) were measured at 1st, 3rd and 7th day of life.

RESULTS:

 

TPO measured on the first day of life did not differ between cases and controls (900.2plusminus526.4 vs 726.6plusminus441.9 pg/ml, p=0.2). It increased on the 3rd day of life and was significantly higher in asphyxiated infants compared to controls (1291.4plusminus627.9 vs 885.5plusminus400.3 pg/ml, respectively; p=0.004). This difference remained significant in a logistic regression model controlling for birth weight, sex and mode of delivery (regression coefficient=476.9plusminus146.8; p=0.002). In asphyxiated infants (n=32), encephalopathy was classified as mild (n=17), moderate (n=10) and severe (n=5). TPO correlated with the degree of clinical severity on the 7th day of life (r=0.59, p=0.003). TPO did not differ between survivors (n=24) and nonsurvivors (n=8) within the asphyxia group (1197.1plusminus596.8 vs 1613.1plusminus605.9 pg/ml; p=0.09). Platelet counts correlated negatively with TPO measured on day 1 (r=-0.415; p=0.02), day 3 (r=-0.64; p=0.001) and day 7 (r=-0.562; p=0.007).

CONCLUSIONS:

 

TPO increased and correlated with severity of asphyxia at 3 and 7 days of life. It correlated negatively with the platelet count at all times.

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