The objective of the study was to test the hypothesis that inflammation modulates fetal erythroblastosis and/or the release of nucleated red blood cells (NRBCs) independent of hypoxia or fetal stress. We sought to determine whether fetal inflammation is associated with an elevation in neonatal NRBC count in the setting of inflammation-associated preterm birth.
The relationships between peripheral NRBC count, histological chorioamnionitis, umbilical cord interleukin (IL)-6, erythropoietin (EPO), cortisol, and acid-base status were analyzed in 68 preterm singletons, born to mothers who had an amniocentesis to rule out infection. Proteomic profiling of amniotic fluid identified presence of intraamniotic inflammation according to established parameters. NRBC counts were assessed within 1 hour of birth. Early-onset neonatal sepsis (EONS) was established based on hematological and microbiological indices. IL-6, EPO, and cortisol levels were measured by immunoassays. Fetal acid-base status was determined within 10 minutes of delivery. Parametric or nonparametric statistics were used.
Fetuses with EONS (n = 19) were delivered at earlier gestational ages (mean +/- SD: 27.1 +/- 2.8 weeks, P = .001) and more often by mothers with intraamniotic inflammation (P = .022) and histological chorioamnionitis (P < .001). Neonates with EONS had higher absolute NRBC counts (P = .011). NRBC counts were directly correlated with cord blood IL-6 levels (P < .001) but not with EPO, cortisol or parameters of acid-base status levels regardless of EONS status. These relationships remained following correction for gestational age, diabetes, intrauterine growth restriction, and steroid exposure.
In the setting of inflammation-associated preterm birth and in the absence of hypoxia, elevations in NRBCs in the early neonatal period may be a direct response of exposure to inflammatory mediators in utero.
"No difference in the mean nRBC count based on the stage after birth was found in ROP and PDA, among the perinatal complications. A previous study reported that the nRBC count increased in infants with early sepsis due to inflammatory reaction36). However, no correlation between newborn infants with sepsis and nRBC count was found in this study. "
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was conducted to investigate the mean nRBC count in very low births weight infants (VLBWIs) and to determine the usefulness of the nRBC as an independent prognostic factors of perinatal complications in VLBWIs.
This study was conducted on 112 VLBWIs who were hospitalized in the neonatal intensive care unit (NICU) of the author's hospital within the period from March 2003 to and May 2008. Based on the infants' nucleated red blood cells (nRBC) counts at birth, on the third day after birth, on the seventh day after birth, in the second week after birth, and in the fourth week after birth in the medical records, the correlation between nRBC or absolute nRBC counts with birth weight, gestational age, and other perinatal outcomes were retrospectively investigated.
In VLBWIs, their mean nRBC and absolute nRBC counts were showing a gradual decrease after birth, and they were consisteantly kept at low values since one week after and inversely proportional to the birth weights. The mean nRBC counts based on the stage after birth showed a significant correlation with perinatal death, necrotizing enterocolitis, and severe intraventricular hemorrhage.
The increase in the nRBC count showed a significant correlation with having a severe intraventricular hemorrhage, necrotizing enterocolitis, and perinatal death in VLBWIs. If an increase or no decrease in the nRBC count after birth is observed, newborn-infant care precautions should be required.
Korean Journal of Pediatrics 02/2011; 54(2):69-78. DOI:10.3345/kjp.2011.54.2.69
"Recent publications indicate that the mechanisms driving nRBC production may not be related only to EPO as previously thought and that it is possible that elevation of nRBCs in the fetal circulation may be an epiphenomenon related to other pathological processes such as oxidative stress and inflammation . Inflammation and specifically IL-6 have been found to have a distinct role in nRBC production and release into the peripheral circulation   . The link between systemic inflammation and fetal erythropoiesis is intriguing when investigating SDB since systemic inflammation has long been implicated in the pathophysiology of this disorder. "
[Show abstract][Hide abstract] ABSTRACT: Eustachian tube dysfunction and sleep-disordered breathing (SDB) share common pathophysiologic mechanisms. Our objective was to investigate whether children referred for isolated TTI (tympanostomy tube insertion) are at increased risk for snoring and upper airway procedures.
Telephone interviews to parents of children who underwent isolated TTI and to age- and gender-matched controls were conducted.
Four hundred fifty-seven children were included in the study; 352 had isolated TTI (study group) and 105 children were controls. Twenty-two percent of children in the study group were reported to snore compared with 7.6% in the controls (p=0.001). Eighteen percent of children in the study group were reported to have undergone adenotonsillectomy compared with 4.8% in the controls (p=0.0005). Future SDB, i.e., either snoring or adenotonsillectomy following TTI, was found in 34% of children in the study group compared with 11% in the controls (p=0.0004). Children who underwent isolated TTI were at increased risk for future snoring (OR=3.4, CI: 1.6-7.2) and future adenotonsillectomy (OR=4.4, CI: 1.7-11.2).
Children who undergo isolated TTI are at increased risk for snoring and for adenotonsillectomy. We suggest that these children be followed for symptoms of SDB on a scheduled basis to allow for early diagnosis and intervention.
Sleep Medicine 02/2010; 11(2):197-200. DOI:10.1016/j.sleep.2009.04.011 · 3.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: For a decade, industrial designers using virtual worlds suffered from equipment costs that were too high and technology that simply could not perform up to expectations. Those problems have now been solved. But designers still have to deal with significant challenges inherent to the design enterprise, challenges made more pressing, ironically, by better, faster, and cheaper technology. In the end, with thought and effort, these problems will be resolved. The use of virtual worlds for the purpose of design will be democratized, become pervasive, and greatly increase shared understanding in businesses and agencies, and among individuals. The author highlights the more pressing challenges and suggests remedies for them, where these exist
Virtual Systems and Multimedia, 2001. Proceedings. Seventh International Conference on; 02/2001
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