Erick Henry

• Master of Public Health - Biostatistics
• Manager at Intermountain Medical Center

Objective To create neonatal reference intervals for the “Micro-R” and “HYPO-He” CBC parameters and to test whether, at early stages of microcytic/hypochromic disorders, while the CBC indices are still normal, these parameters are sensitive, early markers of disease. Study design We retrospectively collected the CBC parameters Micro-R and HYPO-He,...

Objective: To develop a statistically rigorous, hour-specific bilirubin nomogram for newborns based on a very large data set; and use it prospectively as a replacement for the 1999 Bhutani nomogram. Study design: This was a retrospective analysis of first total serum bilirubin (TSB) measurements from 15 years of universal bilirubin screening dur...

To enhance the diagnosis of schistocyte-producing conditions, we compared routine manual schistocyte enumeration with automated fragmented red cell counts (FRCs). In neonates “suspected” of having sepsis, NEC, or DIC we compared manual schistocyte estimates vs. automated FRC counts. When the two disagreed, we used a “gold standard” from a ≥ 1000 RB...

Background: Schistocytes are circulating erythrocyte fragments. They can be identified microscopically from a blood smear; but automated systems evaluate more cells and avoid inconsistencies in microscopy. Studies using adult subjects indicate that automated quantification of schistocytes can be clinically useful. However, reference intervals for...

Advances in clinical laboratory testing can significantly improve medical care. The value of individual tests increases when results become more accurate, interpretation becomes clearer, and turnaround time becomes more rapid. In some cases, neonatology is not at the forefront of advances in clinical laboratory testing, because it is more expeditio...

Professional societies have published recommendations for iron dosing of preterm neonates, but differences exist between guidelines. To help develop standardized guidelines, we performed a 10-year analysis of iron dosing in groups at risk for iron deficiency: IDM (infants of diabetic mothers), SGA (small for gestational age), and VLBW premature neo...

Objective: The immature platelet fraction (IPF) is a laboratory measurement analogous to the reticulocyte count, but reflecting the thrombopoietic state. Similar to a reticulocyte count, it can be expressed as a percent (IPF%=percent of platelets that are immature) or as an absolute number per μl blood; the immature platelet count (IPC=IPF% × plat...

Objective We aimed to evaluate which patient-level factors influence mode of delivery among candidates for operative vaginal delivery. Study Design Cross-sectional study of candidates for operative vaginal delivery from 18 hospitals over 8 years. Probabilities of mode of delivery were estimated using hierarchical logistic modeling adjusting for clu...

Objective. Current American retinopathy of prematurity (ROP) screening guidelines is imprecise for infants ≥ 30 weeks with birth weights between 1500 and 2000 g. Our objective was to evaluate a risk factor based approach for screening premature infants at low risk for severe ROP.Study Design.We performed a 13-year review from Intermountain Health C...

Objective: The neutrophil 'left shift' can be measured via the immature to total (I/T) neutrophil ratio or the absolute bands per μl using a manual differential count. It can also be measured from an automated differential count by the immature granulocyte percentage (IG%) or the absolute IG per μl. In neonates, it is unknown if the manual or auto...

Objective: The automated reticulocyte parameters (absolute reticulocyte count, immature reticulocyte fraction (IRF) and reticulocyte hemoglobin content (RET-He)) are of value in managing adults and older children with a variety of hematological disorders. However, the lack of reference intervals for these parameters in neonates and young infants h...

Thrombocytopenia is common among small-for-gestational-age (SGA) neonates (birth weight <10th percentile reference range), but several aspects of this thrombocytopenia are unclear, including the incidence, typical nadir, duration, association with preeclampsia, mechanism, and risk of death. Using 9 years of multihospital records, we studied SGA neo...

The various blood cell counts of neonates must be interpreted in accordance with high-quality reference intervals based on gestational and postnatal age. Using very large sample sizes, we generated neonatal reference intervals for each element of the complete blood count (CBC). Knowledge of whether a patient has CBC values that are too high (above...

In the first days of life, low grade jaundice is essentially universal. The source of the elevated bilirubin level giving rise to "physiological jaundice of the newborn" is only partly known. We hypothesized that it is, at least in part, the result of active and specific hemolysis involving a physiological mechanism to lower the high fetal hematocr...

Objective: To compare neonatal red blood cell (RBC) transfusion rates in four large Intermountain Healthcare NICUs, all of which adhere to the same RBC transfusion guidelines. Study design: This retrospective analysis was part of a transfusion-management quality-improvement project. De-identified data included RBC transfusions, clinical and labo...

Abstract Objective: To create reference intervals for red blood cell distribution width (RDW) of neonates and to use these intervals to better understand and classify hematopathology of neonates. Study Design: This was a retrospective analysis of data from neonates born between 1/1/2001 and 12/31/2011 who had a CBC in the first 14 days. The first R...

The rate of operative vaginal delivery is on the decline with forceps use declining faster than vacuums. We aimed to determine which clinical factors influence delivery mode (forceps, vacuum, or cesarean) among candidates for operative vaginal delivery in modern practice. Cross-sectional cohort of candidates for operative vaginal delivery (reached...

The decline in operative vaginal delivery contributes to the increase in cesarean delivery. Many obstetricians are using vacuums preferentially. We aimed to determine if physicians who use only vacuums for operative vaginal delivery are more likely to choose cesarean in women who are operative vaginal delivery candidates. Physicians of operative va...

Objective: We instituted a quality improvement process to enhance our capacity to diagnose genetic hemolytic conditions in neonates with extreme hyperbilirubinemia. Study design: During a 1-year period, whenever the total serum bilirubin (TSB) was >25 mg dl(-1) a special evaluation was performed. If we deemed an erythrocyte membrane defect likel...

Objective: The development and evaluation of a labor risk model consisting of a combination of antepartum risk factors and intrapartum fetal heart rate (FHR) characteristics that can reliably identify those infants at risk for adverse neonatal outcome in labor. Study design: A nested case-control study of term singleton deliveries at the nine ho...

Abstract Bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) all likely involve oxidative damage to immature tissues. It has been postulated that transfusions of adult erythrocytes contribute to the risk of developing these morbidities, as a consequence of adult hemoglobin releasing non-physiologi...

Abstract Red blood cell transfusions can be life-saving for neonates with severe anemia or active hemorrhage. However, risks of transfusions exist and should always be weighed against potential benefits. At least two transfusion risks are unique to very low birth weight neonates. The first is an association between transfusions given in the first d...

To create a simple tool for predicting the likelihood of successful trial of labor after cesarean delivery (TOLAC) during the pregnancy after a primary cesarean delivery using variables available at the time of admission. Data for all deliveries at 14 regional hospitals over an 8-year period were reviewed. Women with one cesarean delivery and one s...

Fresh-frozen plasma (FFP) is sometimes administered to nonbleeding preterm neonates who are judged to be at risk for bleeding because they have abnormal coagulation tests. The benefits/risks of this practice are not well defined. One limitation to progress is lack of reference intervals for the common coagulation tests, thus limiting precision abou...

Background Previous reports describe a statistical association, among very-low-birthweight (VLBW, <1500g) neonates, between red blood cell (RBC) transfusion in the first days after birth and development of severe intraventricular (brain) hemorrhage (IVH). Study Design and Methods We hypothesized that after we established a neonatal intensive care u...

Objective: Recent recommendations called for obstetricians to abandon the terms of "hyperstimulation" and "hypercontractility" in favor of the more rigidly defined term, "tachysystole" (TS). The aim of the current study is to describe incidence of and risk factors for TS, describe fetal heart rate (FHR) changes associated with TS, and investigate...

Objective: Our aim was to compare good candidates for trial of labor after cesarean (TOLAC) who underwent repeat cesarean to those who chose TOLAC. Study design: Data for all deliveries at 14 regional hospitals over an 8-year period were reviewed. Women with a primary cesarean and 1 subsequent delivery in the dataset were included. The choice of...

Objective: To estimate whether the decrease in birth weight of term singletons in the United States and elsewhere over the past decade, despite trends in common maternal characteristics expected to contribute toward an increase, is attributable to the simultaneous decrease in gestational length. Methods: Using data from Intermountain Healthcare,...

Objective: The incidence of fetomaternal hemorrhage that is severe enough to cause neonatal anemia is not known. Owing to its relative rarity, much of the literature describing this condition is in the form of case reports and small case series. We performed a large, muiticentered, sequential, case series to determine the incidence, antecedents an...

Due to journal requirements a post-print version of the article is available via private messaging only. We report a series of neonates who developed a total serum bilirubin (TSB) >20mg/dL during a recent ten-year period in a multihospital healthcare system. The incidence of a TSB >20mg/dL fell after instituting a pre-hospital discharge bilirubin...

Objective: Quantitative and qualitative platelet abnormalities of neonates must be defined using evidence-based reference ranges, constructed according to gestational and postnatal age. Methods: Platelet counts, and demographic and outcome data, were obtained from neonates in the Intermountain Healthcare system in the western USA and template bleed...

Reference ranges are an important guide for properly interpreting the clinical laboratory studies obtained from newborn infants. To judge whether the data contained in a CBC (complete blood count) is "normal," a neonatologist cannot utilize the normal ranges of CBCs constructed by sampling healthy adult volunteers. This is because important develop...

The purpose of this study was to determine whether maternal obesity is associated with cesarean delivery and decreased contraction strength in the first stage of labor. We studied a retrospective cohort of women who delivered within a single healthcare system from 2007-2009; we included 5410 women with an intrauterine pressure catheter during the l...

Monochorionicity is associated with increased adverse perinatal outcomes when compared with dichorionicity. The rate of prematurity in monochorionic twins is also higher and contributes to perinatal complications. Many obstetricians recommend elective preterm delivery in monochorionic twin pregnancies to avoid stillbirth and other perinatal complic...

Objective: The best practices for the care of a neonate born after a tight nuchal cord have not been defined. As a step toward this, we compared the outcomes of neonates born after a tight nuchal cord vs those born after a loose nuchal cord vs those born after no nuchal cord. Study design: This was a retrospective comparison using electronic dat...

Our null hypothesis was that the introduction of preoperative hysterectomy checklists for fibroids, dysfunctional uterine bleeding (DUB), and chronic pelvic pain (CPP) would not affect the rate of hysterectomy or the proportion of cases with nonconfirmable final pathology. Using a prospective 6-month cohort, we compared the rate of hysterectomy (us...

Both high and low lymphocyte counts at birth have been associated with adverse outcomes. However, the validity of defining a lymphocyte count as "abnormal" depends on having an accurate reference range. We established a reference range for neonatal lymphocyte counts by using multihospital data and used this to assess previously reported relationshi...

We sought to estimate the optimal time to deliver uncomplicated monochorionic-diamnionic (MCDA) twins. Data were retrospectively obtained from twin pregnancies from 2000 through 2009. The gestational week-specific prospective perinatal mortality risk was calculated. A cohort of MCDA twins with nonindicated deliveries was analyzed separately. Neonat...

Objective: We hypothesized that neonates with bloody stools and concomitant eosinophilia are likely to have atopic enteropathy rather than necrotizing enterocolitis (NEC). Study design: This was a retrospective cross-sectional study using electronic medical records and paper charts. Records of neonates admitted to any Intermountain Healthcare NI...

To estimate the time spent in each fetal heart rate category during labor and during the last 2 hours before delivery in term singleton pregnancy and to estimate the relationship between the time spent in each category and short-term neonatal outcomes. This study reviewed fetal heart rate data and newborn outcomes of women in term labor in 10 hospi...

A subset of necrotizing enterocolitis (NEC) cases is fulminant, characterized by rapid progression to death with massive bowel necrosis found at laparotomy or autopsy. We sought to identify and report all such cases in a multihospital healthcare system during the past 9 years and to characterize this entity using case-control methodologies. This wa...

It is unclear whether neonates born to women with thrombocytopenia during pregnancy are themselves at increased risk for thrombocytopenia at birth. In the current retrospective study, platelet count reference ranges were developed for pregnant women according to trimester, and correlations were sought between the platelet counts of mothers at deliv...

Background: Retinopathy of prematurity (ROP) screening remains a costly and labor-intensive process for neonatal intensive care units. Current AAP guidelines recommend screening all infants born < 1500 gms or ≤ 30 wks or with a birth weight 1500 to 2000 gms with an associated complicated course. Our clinical experience within the Intermountain Heal...

Red blood cell (RBC) transfusions can suppress erythropoiesis. On this basis, RBC transfusions administered to very low birth weight (VLBW) neonates potentially render them more likely to qualify for a subsequent transfusion. We hypothesized that 'late' (>14 days after birth) RBC transfusions given to VLBW neonates result in a decrease in reticuloc...

On the day of birth, the bleeding time of very low birth-weight (VLBW, <1500 g) neonates is generally prolonged, compared with term neonates. However, their bleeding time generally improves (shortens) over the next 7 to 10 days. Ampicillin can prolong the bleeding times of term and late preterm neonates, but its effect on VLBW neonates, who already...

Some preterm infants with a Grade 1 intraventricular hemorrhage (IVH) are subsequently found to have a Grade 3 or 4 IVH, while in others the Grade 1 resolves without extending. We identified all neonates in our health system in the past 6 years with a Grade 1 IVH and compared those where the hemorrhage extended versus resolved. Grade 1 IVH was iden...

We previously reported that in the year 2006, approximately 35% of the transfusions administered in the Intermountain Healthcare neonatal intensive care units (NICU) were noncompliant with our transfusion guidelines. In January 2009 we instituted an electronic NICU transfusion ordering and monitoring system as part of a new program to improve compl...

We sought to compare rates of recurrent spontaneous preterm birth (PTB) and neonatal morbidity between women enrolled in a recurrent PTB prevention clinic compared to those receiving usual care. This was a retrospective cohort study of women with a single, nonanomalous fetus and ≥1 spontaneous PTB <35 weeks. Women enrolled in a recurrent PTB preven...

Objective: Neonatal subgaleal hemorrhage is more common after operative delivery (vacuum or forceps) than after non-instrumented delivery, but can occur when neither vacuum nor forceps were used. We sought to describe recent vacuum and forceps usage in a multihospital system and to identify all cases of subgaleal hemorrhage and to associate these w...

We evaluated neonatal outcomes of apparently stillborn infants. The apparently stillborn neonate is born with an unexpected Apgar score of 0 at 1 minute and is subsequently successfully resuscitated. A retrospective cohort study was performed using electronic medical records for neonates >24 weeks' gestation born between 2002 and 2007. Adverse outc...

Normal saline is sometimes instilled into the endotracheal tube preparatory to airway suctioning, to assist in removing thick secretions. However, saline can damage the antimicrobial properties of airway secretions. We previously described a low-sodium physiologically based solution for airway care and reported a small (n = 60) randomized trial in...

Previous studies reported a relationship between high nucleated red blood cells (NRBC) in neonates and the development of intraventricular hemorrhage (IVH) and/or retinopathy of prematurity (ROP). We sought to (1) establish reference ranges for NRBC in neonates based on a large data set, (2) compare NRBC from automated versus manual counts, (3) det...

A severe intraventricular hemorrhage (IVH) in a preterm neonate can result in life-long disabilities or death. Pathogenic mechanisms responsible for IVH are incompletely understood. We postulated that if the timing of a severe IVH could be approximated by serial ultrasound, potentially relevant antecedents could be identified. We retrospectively id...

Studies in adults indicate that ampicillin, in a dose-dependent manner, impairs platelet function and moderately prolongs the bleeding time (generally by 60 to 90 s). Unlike aspirin, the inhibition induced by ampicillin involves both reversible and irreversible mechanisms and is not observed immediately after initial dosing (generally requiring app...

Blood concentrations of eosinophils and monocytes are part of the complete blood count. Reference ranges for these concentrations during the neonatal period, established by very large sample sizes and modern methods, are needed for identifying abnormally low or high values. We constructed reference ranges for eosinophils per microl and monocytes pe...

Necrotizing enterocolitis (NEC) sometimes occurs after a transfusion, but it is unclear whether this is a chance association or cause and effect. We compared features of neonates that developed surgical NEC within 48 hours after transfusion with others that developed NEC not preceded by transfusion. We assessed the blood used for transfusion and fe...

Severe thrombocytopenia (platelets <or= 50000/microL) in a NICU patient can have significant consequences; however, previous reports have not focused exclusively on NICU patients with counts this low. We identified all patients with severe thrombocytopenia who were cared for in the Intermountain Healthcare level III NICUs from 2003-2007. Among 1128...

Hereditary spherocytosis (HS) is the most common inherited hemolytic disease among people of Northern European decent. Neonates with HS can develop significant hyperbilirubinemia, but we suspect that HS is underrecognized as a cause of neonatal jaundice. We used electronic record repositories of Intermountain Healthcare to identify all neonates wit...

Thrombocytosis has been reported in neonates and young infants, but little is known of its prevalence, timing of onset, associated conditions, sequelae and outcomes. To better understand this condition, we used the data repositories of a multi-hospital health-care system to identify all individuals <or=140 days old (20 weeks) who, during the past 6...

New biopharmaceuticals hold promise for preventing or treating necrotizing enterocolitis. However, it is unclear whether any such biopharmaceutical that requires enteral administration could be administered using an 'early-treatment' paradigm. This study was undertaken to assess this issue based on data from every case of Bell stage III NEC cared f...

Thrombocytopenia and neutropenia among extremely low birth weight neonates Thrombocytopenia and neutropenia are common in the NICU, and might be over represented among extremely low birth weight neonates (ELBW, ≤1000g birth weight). However , little is known about these issues in the ELBW population, thus we performed cohort analyses of ELBW neonat...

The American College of Obstetricians and Gynecologists has recommended that elective deliveries not be performed before 39 weeks of gestation, to minimize prematurity-related neonatal complications. Because a worrisome number of elective deliveries were occurring before 39 weeks of gestation in our system, we developed and implemented a program to...

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 i...

"Normal values" for blood parameters of neonates are generally unavailable, because blood is not usually drawn on healthy, normal neonates to establish normal ranges. Instead, "reference ranges" are used, consisting of the 5th to the 95th percentile values compiled from tests performed on neonatal patients with minimal pathology, under the premise...

"Reference ranges" are developed when it is impossible or inappropriate to establish "normal ranges" by drawing blood on healthy normal volunteers. Reference ranges for the hematocrit and the blood hemoglobin concentration of newborn infants have previously been reported from relatively small sample sizes by using measurement methods that now are c...

In neonatal intensive care unit (NICU) practice, a small percentage of the patients receive a large proportion of the platelet (PLT) transfusions administered. This study sought to better define this very-high-user group. To accomplish this, records of all NICU patients in a multihospital health care system who, during a recent 5(1/2)-year period,...

Objective: Mothers of neonatal intensive care unit (NICU) patients sometimes bring expressed milk that is blood tinged to the NICU. In certain instances, the blood contamination appears minimal, whereas in others, the milk is quite dark pink. We have observed inconsistencies in practice regarding whether or not to feed blood-tinged colostrum or mi...

Concern over in-hospital falls among toddlers and out-of-hospital falls in neonates has led to substantial efforts to prevent these widely recognized problems. In-hospital falls of neonates have received little attention in the medical literature and the authors found no estimates on their incidence or specific programs to prevent them. Electronic...

Identifying a platelet count as abnormal (thrombocytopenia or thrombocytosis) can facilitate recognizing various disease states. However, the published reference ranges for platelet counts in neonates may be imprecise, as they were generated from relatively small sample sizes and compiled before modern platelet enumeration methods. We derived new n...

The fall of a newborn infant to the hospital floor is an error that has received little or no attention in medical publications. We sought to analyze the circumstances surrounding all such falls that occurred in an 18-hospital health care system during a 3-year period. Information was located by using electronic and risk-management records. Demogra...

Ibuprofen might have advantages over indomethacin, when used to effectuate closure of a neonate's patent ductus arteriosus (PDA). Several previous studies indicate that platelet plug formation is impaired after administration of indomethacin, but it is not clear whether a similar impairment occurs following ibuprofen dosing. We performed template b...

We assessed umbilical cord tissue as a means of detecting fetal exposure to five classes of drugs of abuse. In a multicentered study in Utah and New Jersey, we collected umbilical cord tissue when high-risk criteria were met for maternal illicit drug use. The deidentified umbilical cord specimens were analyzed for five drug classes: methamphetamine...

We critically reviewed every NICU blood component transfusion (packed erythrocytes, platelets, frozen plasma (FP) and cryoprecipitate) administered during a one-year period. This was done to determine the proportion of transfusions given out of compliance with the Intermountain Healthcare transfusion guidelines, and to look for patterns of non-comp...

Objective: The template bleeding time is a test used to assess the hemostatic effectiveness of platelet/endothelial interactions. A modified template bleeding time, described over 15 years ago by Andrew et al., has been used to test this aspect of hemostasis in term and preterm infants, but questions remain regarding the effect of gestational age...

Upper and lower reference limits for blood neutrophil concentrations of neonates were reported by Manroe, Rosenfeld and co-workers in 1979 and by Mouzinho, Rosenfeld and co-workers in 1994. Studies by Carballo and co-workers and Maynard and co-workers suggested that at high altitude a much higher upper limit of values occurs, and that neutrophilia...

Necrotizing enterocolitis (NEC) is rare during the first week of life; most cases occur after 2 to 4 weeks. We hypothesized that when NEC develops in the first week, certain predisposing factors and feeding practices are identifiable. To test this, we sought to identify every case of NEC diagnosed during the first week within the Intermountain Heal...

Limited information is available on the expected hematological values of newborn infants with trisomy 18 or trisomy 13 syndromes. About 50% of patients with these conditions survive beyond the first week of life, and some have complete blood counts (CBCs) obtained to assist in medical management. We tabulated all CBC data that had been obtained on...

We tabulated the incidence of necrotizing enterocolitis (NEC) during a recent 4-year period among three neonatal intensive care units (NICUs) within a single health-care system. We then sought associations to explain differences in NEC incidence between the centers. Between January 1, 2002, and December 31, 2005, 6787 neonates were admitted to the...

The erythrocyte indices (mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular hemoglobin (MCH)) were originally reported using hand-calculated values, based on a centrifuge-spun hematocrit, a counting-chamber erythrocyte count and a hemoglobin concentration measured by any number of hemoglobinometry m...

Several studies have indicated a correlation between the number of platelet transfusions received by newborn intensive care unit (NICU) patients and the mortality rate. The number of platelet transfusions might be a marker for level of illness, and thus predictive of mortality. However, an alternative hypothesis is that multiple platelet transfusio...

In the past 5(1/2) years, 30 term or near-term neonates in the Intermountain Healthcare system developed necrotizing enterocolitis (NEC) Bell's stage > or =II. We sought to identify possible explanations for why these patients developed NEC, by comparing them with 5847 others that did not develop NEC, from the same hospitals and of the same gestati...