Limits...
Lamellar body count as a diagnostic test in predicting neonatal respiratory distress syndrome.

Štimac T, Petrović O, Krajina R, Prodan M, Bilić-Zulle L - Croat. Med. J. (2012)

Bottom Line: In premature neonates (<37 gestational weeks), significant differences in LBC were only found between the subgroup without RDS and the group with moderate and the group with severe RDS (P<0.001).In all neonates, significant differences were found between neonates without RDS and neonates with RDS.Using LBC cutoff value of ≥20,000/µL, sensitivity, specificity, and positive and negative predictive values of LBC in determining mature fetal lungs were 96%, 88%, 45.6%, and 99.5%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Tea Stimac, Department of Gynecology and Obstetrics, Perinatology Unit, University Hospital of Rijeka, Cambierieva 17/II, 51000 Rijeka, Croatia, tea.stimac@ri.t-com.hr.

ABSTRACT

Aim: To determine the lamellar body count (LBC) cutoff value for fetal lung maturity and to evaluate the clinical usefulness of LBC in predicting the severity of neonatal respiratory distress syndrome (RDS).

Methods: A prospective study was conducted from 2002 until 2010. LBC was estimated in uncentrifugated amniotic fluid samples using Cell-Dyn 1800 analyzer. Amniotic fluid samples were obtained by amniocentesis or by puncturing embryonic membranes during cesarean section. The presence of mild, moderate, and severe RDS was assessed by neonatologist.

Results: A total of 313 patients with singleton pregnancies (24-41 weeks) were included in the study and 294 met the inclusion criteria. RDS was diagnosed in 28 neonates - mild in 8, moderate in 10, and severe in 10. In premature neonates (<37 gestational weeks), significant differences in LBC were only found between the subgroup without RDS and the group with moderate and the group with severe RDS (P<0.001). In all neonates, significant differences were found between neonates without RDS and neonates with RDS. Using LBC cutoff value of ≥20,000/µL, sensitivity, specificity, and positive and negative predictive values of LBC in determining mature fetal lungs were 96%, 88%, 45.6%, and 99.5%, respectively.

Conclusion: This study suggests that LBC cutoff value of ≥20,000/µL can predict pulmonary maturity and reduce the risk of neonatal respiratory distress syndrome.

Show MeSH

Related in: MedlinePlus

Median values and range of lamellar body counts in amniotic fluid according to gestational age (n = 294).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3368293&req=5

Figure 1: Median values and range of lamellar body counts in amniotic fluid according to gestational age (n = 294).

Mentions: Nineteen out of 313 women were excluded either because their deliveries occurred more than 7 days after amniocentesis or their medical charts were not available. Among 294 patients who met the study criteria, there were 43% nuliparous women. Median maternal age was 30 years (range 16-45) and median gestational age was 37 weeks (range 24-41). Most of them (73%) were delivered by cesarean section. Advanced gestational age was associated with higher LB concentration (Spearman rank correlation coefficient; r = 0.600, P < 0.001) (Figure 1). A total of 47% of neonates were female (n = 142), median weight was 2585 g (range 550-5620), and 13 out of 294 had 5-minute Apgar score <7. RDS was diagnosed in 28 (9.5%) neonates and all of them were premature – 8 neonates had mild, 10 had moderate, and 10 had severe RDS. All 3 neonatal deaths due to acute RDS were in the group of neonates with the most severe clinical form of RDS (24 weeks – LBC 3000/µL; 24 weeks – LBC 2000/µL; 31 weeks – LBC 1000/µL). We found significant differences between neonates with (group B, C, and D) and without RDS (group A) in gestational age, birth weight, 5-minute Apgar score, and mode of delivery (Table 1). We also found significant differences in LBC between the neonates without RDS and all three groups of neonates with various severities of RDS, but there were no significant differences between the groups with mild, moderate, and severe neonatal RDS (Table 2). In premature deliveries <37 gestational weeks, significant differences in amniotic fluid LBC were only found between the subgroup without RDS and the groups with moderate and severe RDS (P < 0.001). The area under the ROC curve for LBC in RDS prediction in neonates was 0.97 (95% confidence interval, 0.94-0.99) (Figure 2). The sensitivity, specificity, and positive and negative predictive values for LBC value ≥20,000/µL in predicting fetal lung maturity were 96%, 88%, 45.6%, and 99.5%, respectively. The likelihood ratio for a positive test was 8.02 and for a negative test was 0.04.


Lamellar body count as a diagnostic test in predicting neonatal respiratory distress syndrome.

Štimac T, Petrović O, Krajina R, Prodan M, Bilić-Zulle L - Croat. Med. J. (2012)

Median values and range of lamellar body counts in amniotic fluid according to gestational age (n = 294).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3368293&req=5

Figure 1: Median values and range of lamellar body counts in amniotic fluid according to gestational age (n = 294).
Mentions: Nineteen out of 313 women were excluded either because their deliveries occurred more than 7 days after amniocentesis or their medical charts were not available. Among 294 patients who met the study criteria, there were 43% nuliparous women. Median maternal age was 30 years (range 16-45) and median gestational age was 37 weeks (range 24-41). Most of them (73%) were delivered by cesarean section. Advanced gestational age was associated with higher LB concentration (Spearman rank correlation coefficient; r = 0.600, P < 0.001) (Figure 1). A total of 47% of neonates were female (n = 142), median weight was 2585 g (range 550-5620), and 13 out of 294 had 5-minute Apgar score <7. RDS was diagnosed in 28 (9.5%) neonates and all of them were premature – 8 neonates had mild, 10 had moderate, and 10 had severe RDS. All 3 neonatal deaths due to acute RDS were in the group of neonates with the most severe clinical form of RDS (24 weeks – LBC 3000/µL; 24 weeks – LBC 2000/µL; 31 weeks – LBC 1000/µL). We found significant differences between neonates with (group B, C, and D) and without RDS (group A) in gestational age, birth weight, 5-minute Apgar score, and mode of delivery (Table 1). We also found significant differences in LBC between the neonates without RDS and all three groups of neonates with various severities of RDS, but there were no significant differences between the groups with mild, moderate, and severe neonatal RDS (Table 2). In premature deliveries <37 gestational weeks, significant differences in amniotic fluid LBC were only found between the subgroup without RDS and the groups with moderate and severe RDS (P < 0.001). The area under the ROC curve for LBC in RDS prediction in neonates was 0.97 (95% confidence interval, 0.94-0.99) (Figure 2). The sensitivity, specificity, and positive and negative predictive values for LBC value ≥20,000/µL in predicting fetal lung maturity were 96%, 88%, 45.6%, and 99.5%, respectively. The likelihood ratio for a positive test was 8.02 and for a negative test was 0.04.

Bottom Line: In premature neonates (<37 gestational weeks), significant differences in LBC were only found between the subgroup without RDS and the group with moderate and the group with severe RDS (P<0.001).In all neonates, significant differences were found between neonates without RDS and neonates with RDS.Using LBC cutoff value of ≥20,000/µL, sensitivity, specificity, and positive and negative predictive values of LBC in determining mature fetal lungs were 96%, 88%, 45.6%, and 99.5%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Tea Stimac, Department of Gynecology and Obstetrics, Perinatology Unit, University Hospital of Rijeka, Cambierieva 17/II, 51000 Rijeka, Croatia, tea.stimac@ri.t-com.hr.

ABSTRACT

Aim: To determine the lamellar body count (LBC) cutoff value for fetal lung maturity and to evaluate the clinical usefulness of LBC in predicting the severity of neonatal respiratory distress syndrome (RDS).

Methods: A prospective study was conducted from 2002 until 2010. LBC was estimated in uncentrifugated amniotic fluid samples using Cell-Dyn 1800 analyzer. Amniotic fluid samples were obtained by amniocentesis or by puncturing embryonic membranes during cesarean section. The presence of mild, moderate, and severe RDS was assessed by neonatologist.

Results: A total of 313 patients with singleton pregnancies (24-41 weeks) were included in the study and 294 met the inclusion criteria. RDS was diagnosed in 28 neonates - mild in 8, moderate in 10, and severe in 10. In premature neonates (<37 gestational weeks), significant differences in LBC were only found between the subgroup without RDS and the group with moderate and the group with severe RDS (P<0.001). In all neonates, significant differences were found between neonates without RDS and neonates with RDS. Using LBC cutoff value of ≥20,000/µL, sensitivity, specificity, and positive and negative predictive values of LBC in determining mature fetal lungs were 96%, 88%, 45.6%, and 99.5%, respectively.

Conclusion: This study suggests that LBC cutoff value of ≥20,000/µL can predict pulmonary maturity and reduce the risk of neonatal respiratory distress syndrome.

Show MeSH
Related in: MedlinePlus