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Comparative Study
. 2019;115(1):49-58.
doi: 10.1159/000491993. Epub 2018 Oct 9.

Can Fetal Umbilical Venous Blood Be a Reliable Source for Admission Complete Blood Count and Culture in NICU Patients?

Rocky Greer  1 , Azif Safarulla  1 , Robin Koeppel  2 , Muhammad Aslam  1 , Fayez M Bany-Mohammed  3
Affiliations
Comparative Study

Can Fetal Umbilical Venous Blood Be a Reliable Source for Admission Complete Blood Count and Culture in NICU Patients?

Rocky Greer et al. Neonatology. 2019.

Abstract

Background: Minimizing initial neonatal blood draws and their associated pain is important. The placenta has ample fetal blood that is otherwise discarded; obtaining admission laboratory evaluations from fetal umbilical venous blood (FUVB) may provide a suitable alternative.

Objective: We hypothesized that obtaining an aerobic bacterial blood culture (BCX) and a complete blood count with manual differential (CBC/diff) from FUVB is feasible and yields results comparable to those obtained directly from the neonate.

Study design: BCX and CBC/diff were attempted on paired samples from FUVB (in the delivery room) and neonatal blood (shortly after NICU admission) of 110 patients. The paired t test, Pearson's correlation coefficient (R), and multivariable linear regression were used for data analysis.

Results: Positive BCXs were found in 9 of 108 FUVB samples compared to 1 of 91 neonatal samples. Three out of 9 FUVB cultures were true pathogens, including 2 Escherichia coli and 1 viridans group streptococcus, all with negative corresponding paired neonatal cultures. There was 1 positive neonatal BCX, E. coli, with a negative paired FUVB culture. Neonatal hemoglobin (Hb), platelets (PLT), and white blood cells (WBC) all significantly (p < 0.0001) correlated with the paired FUVB samples (R = 0.50, 0.49, and 0.84, respectively). Hb, PLT, and WBC values were clinically comparable but statistically higher in neonatal blood (the differences were 2.3 g/dL, 30,000 cells/μL, and 2,800 cells/μL, respectively; p < 0.007 for all comparisons).

Conclusions: FUVB is suitable for obtaining CBC/diff. FUVB is an appropriate second source for BCX as it yields additional true pathogens. Our findings may support the presence of "culture-negative sepsis" in some neonates.

Keywords: Blood count; Blood culture; Cord blood; Neonatal sepsis; Umbilical venous blood.

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Conflict of interest statement

Conflict of interest

The authors declare no competing financial interests or any conflicts of interest in relation to the work described.

Figures

Figure 1.
Figure 1.
Enrollment flow chart for the study population (110 NICU admissions). FUVB: Fetal umbilical venous blood. CBC: complete blood count. BCX: blood culture. WBC: white blood cells.
Figure 2.
Figure 2.
Scatter plot of hemoglobin (A), platelets (B) and white blood cells (C) fetal umbilical venous blood and admission neonatal blood.
See this image and copyright information in PMC

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