Discordant Transient Extreme Hyperleukocytosis in Dichorionic Diamniotic Twins: The Role of the Sex?

Although a leukemoid reaction is a well-recognized phenomenon in the neonatal intensive care unit, transient extreme hyperleukocytosis in premature infants is rare. The exact mechanism is still unclear and several hypotheses are documented in the literature. In this case report, we describe 2 dichorionic diamniotic premature twins, of whom the 2 girls had extreme hyperleukocytosis, whereas their siblings did not, emphasizing the potentially important role of the sex in this phenomena.

Evaluation of strategies regarding management of imminent preterm delivery before 32 weeks of gestation: a regional cohort study among 1375 women in the Netherlands.

OBJECTIVE: To evaluate the management of imminent preterm delivery with respect to prescription of antenatal corticosteroids (ACS) and referral to a tertiary center. STUDY DESIGN: A retrospective cohort study existing of 1 perinatal center and 9 referring hospitals. All women who received their first dose of ACS in 1 of the 10 hospitals between 24+0 and 32+0 weeks of gestation and/or delivered before 32 weeks of gestation from 2005 until 2010. Patients were identified using the electronic database of hospital pharmacies. Main outcome measures were time interval from administration to delivery for different indications and number of women who were not referred in time to a tertiary center. RESULTS: In total, 1375 women received ACS. Main indications were suspected preterm labor (44.7%), preterm prelabor rupture of membranes (15.9%), maternal indication (12.8%), fetal indication (9.2%) and vaginal blood loss (8.4%). Overall, 467 (34.0%) women delivered ≤7 days after ACS administration; 8.7% of women with vaginal blood loss and 54.5% of women with maternal indication. Among the 931 women who received ACS in the secondary hospitals, 452 (48.5%) women were referred to a tertiary hospital and 89 (6.5%) women delivered in a secondary hospital with a gestational age of less than 32 weeks. CONCLUSION: One-third of all women receiving ACS delivered within 7 days and half of the women who received ACS in a secondary hospital were referred to a tertiary center. There seems to be room for improvement regarding the timing of ACS administration and subsequently referral to a tertiary center.

Evaluation of antenatal corticosteroid prescribing patterns among 984 women at risk for preterm delivery.

OBJECTIVE: To evaluate the prescribing patterns of the first antenatal corticosteroids (ACS) course in our tertiary referral centre from 2005 until 2010. STUDY DESIGN: We conducted a retrospective cohort study including all women who received ACS between 24(+0) and 34(+0) weeks of gestation. Main outcome measure was the number of women who delivered within 7 d after ACS administration. The time interval from administration to delivery was compared between women with different indications. Furthermore, all women delivering between 24(+0) and 34(+0) weeks of gestation who did not receive ACS were identified. RESULTS: 1008 women received ACS, 15 (1.5%) women were lost to follow up. Main indications were suspected preterm labour, preterm prelabour rupture of membranes, maternal indication, foetal indication and vaginal blood loss (VBL). Overall, 447 (45.4%) women delivered ≤7 d after ACS administration. This percentage was 13.6% in women with VBL and 61.5% in women with maternal indication. During the study period, 1267 women delivered before 34 weeks of gestation, 126 (9.9%) women did not receive ACS. CONCLUSIONS: The time interval from ACS administration to delivery differs per indication. Women with VBL are most often over treated. The timing of the first ACS course should be improved.