Neonatal neutropenia. Clinical manifestations, cause, and outcome
J. E. Baley, E. K. Stork, P. I. Warkentin and S. B. Shurin
Department of Pediatrics, Rainbow Babies and Childrens Hospital, Cleveland, OH 44106.
Neutropenia, defined as an absolute neutrophil count that falls below 2.0 x
10(9)/L, is being identified more frequently in the newborn intensive care
unit and significantly influences clinical decisions regarding therapy. We
prospectively identified 119 episodes of neutropenia in 87 infants (6% of
admissions). Less than half of the episodes could be attributed to
infections. The majority of noninfectious neutropenia episodes were related
to specific perinatal events or were of unknown cause. Infants weighing
less than 2500 g were more likely to have neutropenia than term infants
(13% vs 3%, respectively) and less likely to have neutropenia related to
bacterial infections. Short-term survival (89% vs 95%) and long-term
survival (74% vs 77%) were not different in infants with infectious
diseases compared with those with noninfectious diseases. Mortality was
highly correlated with the need for assisted ventilation (20%) or with an
absolute neutrophil count of 0.5 x 10(9)/L (24%). We conclude that the
cause of neutropenia and the clinical condition must be carefully evaluated
before instituting aggressive therapy for infection.
