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Estimating the nucleated red blood cell ‘emergence time’ in neonates

Journal of Perinatology volume 34, pages 116–119 (2014)Cite this article

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Abstract

Objective:

The time between onset of fetal hypoxia and first appearance of nucleated red blood cells (NRBCs) in the blood can conceptually be divided into two periods; (1) the ‘erythropoietin (EPO) generation time’, which previous fetal studies suggest is 4 to 5 h, and (2) the ‘NRBC emergence time’. In this study, we estimated the latter as the time required for NRBC to appear in the blood after administering a dose of recombinant EPO.

Study Design:

This was a retrospective analysis of data from a multihospital healthcare system (Intermountain Healthcare). Data were included only for neonates born ⩾34 weeks gestation between the dates 1 January 2005 and 31 October 2012 and only if they received a dose of darbepoetin during their neonatal intensive care unit stay and had one or more complete blood cell counts (CBCs) obtained during the 3-day period before the dose was given and one or more CBCs in the 7-day period after the dose.

Result:

The study involved 31 neonates who received 34 doses of darbepoetin. Seven doses were 4 μg kg−1 and twenty-seven doses were 10 μg kg−1. Twenty-six CBCs were obtained during the 24-h period following the darbepoetin dose and none had NRBC identified. NRBC first appeared in the blood between 24 and 36 h after the dose. Recipients of the higher dose generally had a higher peak NRBC count but the NRBC ‘emergence time’ did not appear to depend on dose.

Conclusion:

Following fetal hypoxia, transcription and translation of the EPO gene result in an elevation in plasma EPO concentration. Previous fetal studies suggest this process requires 4 to 5 h. The present studies suggest that, following the increase in plasma EPO, NRBC emerge into the circulation in ⩾24 h. If this model serves as a reasonable estimate, it suggests that neonates with an elevated NRBC count at birth had the onset of hypoxia at least 28 to 29 h before birth.

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Acknowledgements

We thank Josef T Prchal, MD, Departments of Internal Medicine, Genetics, and Pathology, University of Utah School of Medicine, for critically reviewing the manuscript, and Vickie L Baer, RN, Intermountain Healthcare Research, for assistance with data management.

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Authors and Affiliations

  1. Department of Women and Newborns, Intermountain Healthcare, Salt Lake City, UT, USA

    R D Christensen, D K Lambert & D S Richards

  2. Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA

    D S Richards

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Correspondence to R D Christensen.

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Christensen, R., Lambert, D. & Richards, D. Estimating the nucleated red blood cell ‘emergence time’ in neonates. J Perinatol 34, 116–119 (2014). https://doi.org/10.1038/jp.2013.113

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