Download PDF
Am J Perinatol 2015; 32(07): 653-658
DOI: 10.1055/s-0034-1390353
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hematological Parameters Immediately after Birth in Twins and Higher Order Multiples

Jyotsna Shah
1   Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
,
Prakesh S. Shah
1   Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
,
Ann Jefferies
1   Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada
› Author Affiliations
Further Information

Publication History

17 July 2014

30 July 2014

Publication Date:
21 November 2014 (online)

    Permissions and Reprints

Abstract

Objective To develop reference values for hematological parameters in twins and higher order multiple births immediately after birth and compare them with values from singletons.

Study Design In this retrospective matched cohort study, hematological parameters immediately after birth from multiples, and gestation- and sex-matched singletons born between 2007 and 2009 were obtained. Infants born with maternal or fetal conditions known to affect hematological values were excluded. Data were compared using Student t-test, chi-square test, and nonparametric tests as appropriate.

Results Three hundred sixty-three multiples were matched with 363 singletons. Multiples had lower birth weights and higher rate of conception by in-vitro fertilization than singletons. Mean (SD) hemoglobin (171 ± 24 vs. 167 ± 23 g/L; p = 0.04) was marginally higher but nucleated red cells were 30% lower (1.7 ± 2.6 vs. 2.6 ± 3.9 109/L, p < 0.01) in multiples. Total white blood cells (WBCs) were 14% lower, absolute neutrophils 30% lower, monocytes 31% lower, basophils 28% lower, and immature WBC 56% lower in multiples.

Conclusion Mean hemoglobin was higher, whereas total WBC, absolute neutrophils, monocytes, and eosinophils were significantly lower in multiples compared with singletons. These differences in WBC and neutrophil counts should be considered when interpreting hematological parameters in multiples.

Keywords

complete blood count - plurality - twins - sepsis risk
 

  • References

  • 1 Atanasova V, Mumdiev C, Nedkova V, Krusteva M, Hristova E. [Impact of the multiple births on the postnatal blood count indices in premature infants]. Akush Ginekol (Sofiia) 2013; 52 (6) 3-10
    PubMedGoogle Scholar
  • 2 Manroe BL, Weinberg AG, Rosenfeld CR, Browne R. The neonatal blood count in health and disease. I. Reference values for neutrophilic cells. J Pediatr 1979; 95 (1) 89-98
    CrossrefPubMedGoogle Scholar
  • 3 Mouzinho A, Rosenfeld CR, Sánchez PJ, Risser R. Revised reference ranges for circulating neutrophils in very-low-birth-weight neonates. Pediatrics 1994; 94 (1) 76-82
    PubMedGoogle Scholar
  • 4 Xanthou M. Leucocyte blood picture in healthy full-term and premature babies during neonatal period. Arch Dis Child 1970; 45 (240) 242-249
    CrossrefPubMedGoogle Scholar
  • 5 Mori H, Mori K, Kojima Y , et al. Neonatal nucleated red blood cell counts in twins. J Perinat Med 2001; 29 (2) 144-150
    CrossrefPubMedGoogle Scholar
  • 6 Christensen RD, Jopling J, Henry E, Wiedmeier SE. The erythrocyte indices of neonates, defined using data from over 12,000 patients in a multihospital health care system. J Perinatol 2008; 28 (1) 24-28
    CrossrefPubMedGoogle Scholar
  • 7 Lopriore E, Slaghekke F, Oepkes D, Middeldorp JM, Vandenbussche FP, Walther FJ. Hematological characteristics in neonates with twin anemia-polycythemia sequence (TAPS). Prenat Diagn 2010; 30 (3) 251-255
    CrossrefPubMedGoogle Scholar
  • 8 Green DW, Elliott K, Mandel D, Dollberg S, Mimouni FB, Littner Y. Neonatal nucleated red blood cells in discordant twins. Am J Perinatol 2004; 21 (6) 341-345
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Sheffer-Mimouni G, Littner Y, Mimouni FB, Mandel D, Deutsch V, Dollberg S. Nucleated red blood cells in concordant, appropriate-for-gestational age twins. Am J Obstet Gynecol 2004; 191 (4) 1291-1295
    CrossrefPubMedGoogle Scholar
  • 10 Barrington KJ. Canadian Paediatric Society Fetus and Newborn Committee Management of the infant at increased risk for sepsis. Paediatr Child Health 2007; 12: 893-905
    PubMedGoogle Scholar
  • 11 Perrone S, Vezzosi P, Longini M , et al; Gruppo di Studio di Ematologia Neonatale della Società Italiana di Neonatologia. Nucleated red blood cell count in term and preterm newborns: reference values at birth. Arch Dis Child Fetal Neonatal Ed 2005; 90 (2) F174-F175
    CrossrefPubMedGoogle Scholar
  • 12 Koenig JM, Christensen RD. The mechanism responsible for diminished neutrophil production in neonates delivered of women with pregnancy-induced hypertension. Am J Obstet Gynecol 1991; 165 (2) 467-473
    Google Scholar
  • 13 Bajoria R, Ward S, Sooranna SR. Erythropoietin in monochorionic twin pregnancies in relation to twin—twin transfusion syndrome. Hum Reprod 2001; 16 (3) 574-580
    CrossrefPubMedGoogle Scholar
  • 14 Verani JR, McGee L, Schrag SJ ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease—revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59 (RR-10) 1-36
    PubMedGoogle Scholar