title: Early-Onset Neutropenia in Small-for-Gestational-Age Infants.
abstract: BACKGROUND
  Early neutropenia is more common in small for gestational age (SGA) neonates (birth weight <10th percentile) than in appropriately grown neonates. However, several aspects of this variety of neutropenia are unknown, including the duration, kinetic mechanism, and outcomes.
  
  
  METHODS
  Using 10 years of multihospital records, we studied SGA neonates who, during the first week after birth, had neutrophil counts <1000/μL.
  
  
  RESULTS
  This degree of neutropenia was more common in SGA neonates (6%, 207/3650) than in non-SGA matched controls (1%, 46/3650; P < .001). Neutrophil counts stayed below the lower reference interval for 7 days. Ratios of immature to total neutrophils were within the reference interval, suggesting reduced neutrophil production, not accelerated neutrophil use or destruction. Increased nucleated red cells at birth correlated with decreased neutrophils (P < .001). Neutropenia was not independently associated with maternal hypertensive disorders, over and above the effect of SGA. Of 201 neutropenic SGA neonates, 129 (64%) also had thrombocytopenia. Sixteen percent of neutropenic neonates were treated with recombinant granulocyte colony-stimulating factor (rG-CSF) or intravenous immunoglobulin (IVIG), with no reduction in late-onset sepsis or necrotizing enterocolitis (NEC). Regression analysis showed that neutropenia (but not thrombocytopenia in the absence of neutropenia) was independently associated with increased odds of developing necrotizing enterocolitis (odds ratio 4.01, 90% confidence interval 2.08 to 7.35, P < .001).
  
  
  CONCLUSIONS
  Neutropenia of SGA is a condition of 1-week duration. It is more closely associated with SGA than maternal hypertension (likely owing to neutrophil hypoproduction associated with intrauterine hypoxia), often accompanied by thrombocytopenia, not obviously improved by rG-CSF or IVIG, and associated with an increased risk for NEC.
authors.affiliation: Women and Newborn's Clinical Program, Intermountain Healthcare, Division of Hematology/Oncology, and Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah; and robert.christensen@hsc.utah.edu.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Christensen
authors.affiliation: Women and Newborn's Clinical Program, Intermountain Healthcare, Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah; and.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Yoder
authors.affiliation: Women and Newborn's Clinical Program, Intermountain Healthcare.
authors.forename: Vickie L
authors.initials: VL
authors.lastname: Baer
authors.affiliation: Statistical Data Center, LDS Hospital, Salt Lake City, Utah.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Snow
authors.affiliation: Statistical Data Center, LDS Hospital, Salt Lake City, Utah.
authors.forename: Allison
authors.initials: A
authors.lastname: Butler
mesh_terms: D017668:Age of Onset; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D009503:Neutropenia / Q000453:epidemiology*; D012044:Regression Analysis; D013921:Thrombocytopenia / Q000453:epidemiology