Validity of Lamellar Body Count as a Fetal Lung Maturity Assessment in Twin Pregnancy

Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan.
Twin Research and Human Genetics (Impact Factor: 2.3). 08/2012; 15(4):547-9. DOI: 10.1017/thg.2012.29
Source: PubMed


Fetal lung maturity assessment in twin pregnancy has been discussed, but is still controversial. The purpose of this study is to predict the occurrence of respiratory distress syndrome (RDS) using lamellar body count (LBC) and analyze the validity of LBC for fetal lung maturity assessment in twin pregnancy. Three-hundred two amniotic fluid samples were obtained at cesarean section from 29 to 38 weeks of gestation. Samples were analyzed immediately with no centrifugation and the number of lamellar bodies was counted using a platelet channel on the Sysmex SF-3000. There were 18 neonates (6.0%) suffering from RDS. An LBC cut-off value of 2.95×10⁴/μL resulted in 91.5% sensitivity and 83.3% specificity for predicting RDS. This cut-off value for predicting RDS was the same as that in singleton pregnancy. Moreover, the median LBC value in RDS cases was significantly lower than in non-RDS cases (1.50±1.1×10⁴/μL vs. 10.6±7.5×10⁴/μL; p<.001). This is the first report on the validity of LBC in twin pregnancy and also the largest study on fetal lung maturity assessment in twin pregnancy. An LBC value of >2.95×10⁴/μL means reassuring findings for RDS even in twin pregnancy. We believe the data in this study provide valuable, new information for the management of twin pregnancies.

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Available from: Tomomi Kotani, May 10, 2014
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    ABSTRACT: Twin pregnancies have a higher rate of preterm births, making precise prediction of neonatal respiratory disorders essential. We herein examined the amniotic lamellar body count (LBC) and found it to be an accurate predictor of respiratory disorders in twin pregnancies. Five hundred fourteen amniotic fluid samples, comprising 132 dichorionic twins (DCT) and 125 monochorionic twins (MCT) gestations, were obtained at Cesarean section performed at 29 to 38 gestational weeks. Samples were analyzed immediately without centrifugation. There were 26 neonates (5.1%) with respiratory distress syndrome (RDS) and 43 (8.4%) with transient tachypnea of the newborn (TTN). The LBC in neonates with TTN (5.12×10(4)/μl) was between the counts in RDS (1.26×10(4)/μL) and controls (10.6×10(4)/μl), which differed significantly. Twin concordance rates were significantly higher for TTN in MCT gestations than DCT gestations (p=0.003) and delta LBC value was significantly smaller in MCT (3.15±0.4×10(4)/μL) than DCT (5.17±0.5×10(4)/μL) gestations (p=0.003). The amniotic LBC is useful for predicting respiratory disorders, including RDS and TTN, in twin pregnancies. The data in this study may indicate a genetic predisposition to TTN among MCT. Copyright © 2014. Published by Elsevier B.V.
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    ABSTRACT: Introduction: Respiratory distress syndrome (RDS) due to lack of enough surfactant in fetal lung tissue is one of the common causes of neonatal mortality. There are several laboratory methods to determine the amount of fetal lung surfactant. The purpose of this study is to assess the lamellar body count for prediction of the amount of pulmonary surfactant for diagnosis of neonatal respiratory distress syndrome in premature neonates. Method: This cross-sectional and applied study was performed on 91 infants with gestational age between 28-40 weeks for 6 months in 2013. In this study, lamellar body count test was performed for all infants. Lamellar body count was performed by a cell counter (Sysmex model K-X21). ROC Curve was also used for data analysis. Results: Among 91 samples, 14 cases (15.4%) had respiratory distress syndrome. There were significant relationship between the prevalence of respiratory distress and gender (P=0.05), gestational age (P=0.01) and neonatal weight (P=0.01). The best cut off point for lamellar body count was less or more than 22500. Also, sensitivity, specificity, positive and negative predictive values were 94.7%, 100%, 100% and 94.7%, respectively. Conclusion: Lamellar body count is a useful test for screening in terms of neonatal pulmonary surfactant. The test has appropriate sensitivity and specificity in the diagnosis of respiratory distress syndrome. © 2015, Mashhad University of Medical Sciences. All rights reserved.
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    ABSTRACT: Background: The amniotic lamellar body count (LBC) is useful for predicting respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) in twin pregnancies. However, the risk of neonatal respiratory complications varies with gestational age (GA). We herein created a model to predict the risk for RDS and TTN using GA and the LBC in twin pregnancies. Methods: Six hundred thirty-two amniotic fluid samples, comprising 169 dichorionic twin (DCT) and 147 monochorionic twin (MCT) gestations, were obtained at Cesarean section. The samples were analyzed immediately without centrifugation. A logistic regression model including the LBC and GA was used to develop the prediction model for RDS/TTN. Results: There were 101 neonates (16.0%) with RDS/TTN. The GA and LBC were significant independent factors affecting RDS/TTN. According to the logistic regression model, we determined the probability of RDS/TTN given the values of GA and the LBC. The overall diagnostic accuracy for predicting neonatal RDS/TTN using GA and the LBC was higher than the use of the LBC alone. Conclusions: GA-specific LBC cutoffs for the risk assessment of neonatal RDS/TTN have been considered to be more accurate in twin pregnancies. Our findings provide valuable, new information for the management of twin pregnancies.
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