Opinions regarding neonatal resuscitation training for the obstetric physician: a survey of neonatal and obstetric training program directors.

PURPOSE: Our goal was to garner opinions regarding neonatal resuscitation training for obstetric physicians. We sought to evaluate obstacles to neonatal resuscitation training for obstetric physicians and possible solutions for implementation challenges. MATERIALS AND METHODS: We distributed a national survey via email to all neonatal-perinatal medicine fellowship directors and obstetrics & gynecology residency program directors in the United States. This survey was designed by a consensus method. RESULTS: Ninety-eight (53%) obstetric and fifty-seven (51%) neonatal program directors responded to our surveys. Eighty-eight percent of neonatologists surveyed believe that obstetricians should be neonatal resuscitation program (NRP) certified. The majority of surveyed obstetricians (>89%) believe that obstetricians should have some neonatal resuscitation training. Eighty-six percent of obstetric residents have completed training in NRP, but only 19% of obstetric attendings are NRP certified. Major barriers to NRP training that were identified include time, lack of national requirement, lack of belief it is helpful, and cost. CONCLUSIONS: Most obstetric attendings are not NRP certified, but the majority of respondents believe that obstetric providers should have some neonatal resuscitation training. Our study demonstrates that most respondents support a modified neonatal resuscitation course for obstetric physicians.

Simulation as a tool for improving acquisition of neonatal resuscitation skills for obstetric residents.

OBJECTIVE: Our goal was to compare the confidence, knowledge, and performance of obstetric residents taught initial neonatal resuscitation steps in a simulation-based versus lecture-based format. METHODS: Our study was a prospective randomized controlled trial of 33 obstetric residents. Baseline confidence, knowledge, and clinical skills assessments were performed. Subjects were randomized to traditional lecture (n = 14) or simulation-based (n = 19) neonatal resuscitation curriculum with a focus on initial steps. Follow-up assessments were performed at 3 and 6 months. Total confidence, knowledge, and clinical performance scores and change from baseline in these scores were calculated and compared between groups. RESULTS: Both the lecture-based and simulated-based groups demonstrated significant improvement in confidence, knowledge, and performance over time. However, compared with the lecture group, the magnitude of the mean change from baseline in performance scores was significantly greater in the simulation group at 3 months (2.9 versus 10.1; p < 0.001), but not at 6 months (7.0 versus 9.3; p = 0.11). CONCLUSIONS: Our study demonstrates the superiority of simulation in teaching obstetric residents initial neonatal resuscitation steps compared with a traditional lecture format. Skills are retained for upwards of 3-6 months. Refresher instruction by 6 months post-instruction may be beneficial.

Senior-Løken syndrome: a syndromic form of retinal dystrophy associated with nephronophthisis.

Senior-Løken syndrome (SLS) is an autosomal recessive disease characterized by development of a retinitis pigmentosa (RP)- or Leber congenital amaurosis (LCA)-like retinal dystrophy and a medullary cystic kidney disease, nephronophthisis. Mutations in several genes (called nephrocystins) have been shown to cause SLS. The proteins encoded by these genes are localized in the connecting cilium of photoreceptor cells and in the primary cilium of kidney cells. Nephrocystins are thought to have a role in regulating transport of proteins bound to the outer segment/primary cilium; however, the precise molecular mechanisms are largely undetermined. This review will survey the biochemistry, cell biology and existing animal models for each of the nephrocystins as it relates to photoreceptor biology and pathogenesis of retinal degeneration.

Skin carotenoid status measured by resonance Raman spectroscopy as a biomarker of fruit and vegetable intake in preschool children.

BACKGROUND/OBJECTIVE: Dietary assessment in children is difficult, suggesting a need to develop more objective biomarkers of intake. Resonance Raman spectroscopy (RRS) is a non-invasive, validated method of measuring carotenoid status in skin as a biomarker of fruit/vegetable intake. The purpose of this study was to examine the feasibility of using RRS in preschool children, to describe inter-individual variability in skin carotenoid status and to identify factors associated with the biomarker in this population. SUBJECTS/METHODS: We conducted a cross-sectional study of 381 economically disadvantaged preschoolers in urban centers in Connecticut (USA). In all, 85.5% were black non-Hispanic or Hispanic/Latino, and 14.1% were obese and 16.9% were overweight by age- and sex-specific body mass index (BMI) percentiles. Children had their skin carotenoid status assessed by RRS in the palm of the hand. Fruit/vegetable consumption was assessed by a brief parent/guardian-completed food frequency screener and a liking survey. RESULTS: We observed inter-individual variation in RRS values that was nearly normally distributed. In multiple regression analysis, higher carotenoid status, measured by RRS, was positively associated with fruit/vegetable consumption (P=0.02) and fruit/vegetable preference (P<0.01). Lower carotenoid status was observed among younger children, those participating in the US Supplemental Nutrition Assistance Program, and those with greater adiposity (P<0.05 for all). CONCLUSIONS: We observed wide variability in skin carotenoid status in a population of young children, as assessed by RRS. Parent-reported fruit/vegetable intake and several demographic factors were significantly associated with RRS-measured skin carotenoid status. We recommend further development of this biomarker in children, including evaluating response to controlled interventions.

Demographics and awareness of diabetic retinopathy among diabetic patients attending the vitreo-retinal service at a tertiary eye care center in Nepal.

INTRODUCTION: Diabetic retinopathy (DR) is one of the leading causes of blindness in Nepal. OBJECTIVE: To investigate the demographic characteristics and awareness of diabetic retinopathy among new cases of diabetes mellitus (DM) attending the vitreo-retinal service of a tertiary eye care centre in Nepal. MATERIALS AND METHODS: A hospital-based, cross-sectional study including all consecutive new cases of DM was carried out. Detailed demographics of the subjects and their awareness of potential ocular problems from diabetes mellitus were noted. RESULTS: A total of 210 patients with a mean age of 57 +/- 10.4 years were included. Brahmins (34.8 %) and Newars (34.3 %) were the predominant ethnic groups. Housewives (38.6 %) and office workers (18.6 %) were the major groups affected. Two-fifths (37 %) of the cases were unaware of DR and its potential for blindness. Awareness was significantly higher among literate patients (P = 0.006). Fundus evaluation was done for the first time in 48.6 %, although almost four-fifths had a duration of diabetes of five years or more. DR was found in 78 % of the cases, with 16.7 % already at the proliferative stage and about 40 % exhibiting clinically significant diabetic macular edema. CONCLUSION: A lack of awareness of DR coupled with a high proportion of cases already at a sight-threatening stage of retinopathy at their first presentation reflects the need for improved awareness programs to reduce the burden of blindness from DR in Nepal.

Nutritional Interventions against Age-Related Macular Degeneration.

Age-related macular degeneration (AMD) is the leading cause of irreversible visual loss in the developed world. This disease of the elderly robs them of central vision in one or both eyes leading to a devastating loss of the ability to drive, read, and recognize faces. In recent years, a number of novel treatments for the neovascular form of AMD (also known as "wet" or exudative AMD) have been introduced, and for the first time, the relentless downhill course of vision loss experienced by the majority of patients with this particularly malignant variant of AMD has been transformed to the stabilization and even improvement of vision in at least two-thirds of patients. Likewise, the slower, more insidious form of AMD known as dry AMD which leads to geographic atrophy of the macula has become the focus of pharmaceutical firms' efforts for intervention. Unfortunately, all of these novel treatments have limitations, and they tend to be very expensive. Thus, prevention of AMD is of paramount importance to reduce the healthcare burden of this blinding disorder. Accumulating evidence suggests that encouragement of increased consumption of fruits and vegetables rich in the xanthophyll carotenoids lutein and zeaxanthin is a simple, cost effective public health intervention that might help to decrease the incidence of AMD. In this review article, the scientific underpinnings for these nutritional recommendations will be surveyed.

Factorial analysis of tricarboxylic acid cycle intermediates for optimization of zeaxanthin production from Flavobacterium multivorum.

AIMS: To study the effect of intermediates of the tricarboxylic acid (TCA) cycle on the production of zeaxanthin from Flavobacterium multivorum in order to optimize production of this xanthophyll carotenoid. METHODS AND RESULTS: The concentration of selected TCA cycle intermediates (malic acid, isocitric acid and alpha-ketoglutarate) was optimized in shake flask culture, using a statistical two-level, three-variable factorial approach. The carotenoid production profile was also studied in the optimized medium at various growth phases. Optimized medium resulted in a sixfold increase in volumetric production of zeaxanthin (10.65 +/- 0.63 microg ml-1) using malic acid (6.02 mm), isocitric acid (6.20 mm) and alpha-ketoglutarate (0.02 mm). The majority of zeaxanthin was produced in the late logarithmic growth phase whereas a substantial amount of beta-cryptoxanthin and beta-carotene were observed in the early logarithmic phase. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrates improvement of zeaxanthin production from F. multivorum which might aid in the commercialization of zeaxanthin production from this microbe.

Diverse macular dystrophy phenotype caused by a novel complex mutation in the ELOVL4 gene.

PURPOSE: A 5-bp deletion in ELOVL4, a photoreceptor-specific gene, has been associated with autosomal dominant (ad) macular dystrophy phenotypes in five related families, in which phenotypes range from Stargardt-like macular dystrophy (STGD3; Mendelian Inheritance in Man 600110) to pattern dystrophy. This has been the only mutation identified in ELOVL4 to date, which is associated with macular dystrophy phenotypes. In the current study, the potential involvement was investigated of an ELOVL4 gene variation in adSTGD-like and other macular dystrophy phenotypes segregating in a large unrelated pedigree from Utah (K4175). METHODS: The entire open reading frame of the ELOVL4 gene was analyzed by direct sequencing in a proband from the K4175 family. The combination of denaturing high-performance liquid chromatography (DHPLC) analysis and direct sequencing of all available family members was used to further assess segregation of identified ELOVL4 variants in the pedigree. RESULTS: A complex mutation, two 1-bp deletions separated by four nucleotides, was detected in all affected members of the family. The mutation results in a frameshift and the truncation of the ELOVL4 protein, similar to the effect of the previously described 5-bp deletion. CONCLUSIONS: The discovery of a second mutation in the ELOVL4 gene segregating with macular dystrophy phenotypes confirms the role of this gene in a subset of dominant macular dystrophies with a wide range of clinical expressions and suggests a role for modifying genes and/or environmental factors in the disease process.

Assessment of mutations in the Best macular dystrophy (VMD2) gene in patients with adult-onset foveomacular vitelliform dystrophy, age-related maculopathy, and bull's-eye maculopathy.

PURPOSE: To study the presence of Best macular dystrophy (VMD2) gene mutations in patients diagnosed with maculopathies other than classic Best disease and to describe the clinical characteristics of these subjects. DESIGN: Case-comparison study of phenotype-genotype correlations. METHODS: Patients with either age-related maculopathy (ARM; n = 259) or maculopathies other than classic Best disease (n = 28) were screened for mutations in the Best gene (VMD2; OMIM 153700). These cases were compared with ethnically similar subjects in the same age range without maculopathy (n = 196). All patients underwent a complete dilated ocular examination, and all affected individuals underwent fundus photography. Phenotype-genotype comparisons were made. MAIN OUTCOME MEASURES: Presence of mutations in the Best gene (VMD2; OMIM 153700) and the clinical phenotype. RESULTS: Three of 259 patients (1%) with ARM and 2 of 28 patients (7%) with other maculopathies including 1 of 3 patients with adult-onset foveomacular vitelliform dystrophy and 1 of 5 patients with a bull's eye maculopathy, but none of the controls, were found to possess amino acid-changing variants in the VMD2 gene. These included a man with confluent drusen and retinal pigment epithelial detachments (variant in exon 6; T216I), a man with geographic atrophy and numerous soft drusen (variant in exon 10; L567F), a woman with drusen and retinal pigment epithelial alterations (variant in exon 10; L567F), a woman with drusen and retinal pigment epithelial alterations resembling bull's-eye maculopathy (variant in exon 4; E119Q), and a woman diagnosed with adult-onset foveomacular vitelliform dystrophy (variant in exon 4; A146K). CONCLUSIONS: Novel mutations in the VMD2 gene were found in patients diagnosed with maculopathies other than classic Best disease. Some cases diagnosed as adult-onset vitelliform foveomacular dystrophy may represent a variant of Best disease with delayed onset. The VMD2 gene does not play a major role in the development of ARM.

Evaluation of the G protein coupled receptor-75 (GPR75) in age related macular degeneration.

BACKGROUND: A long term project was initiated to identify and to characterise genes that are expressed exclusively or preferentially in the retina as candidates for a genetic susceptibility to age related macular degeneration (AMD). A transcript represented by a cluster of five human expressed sequence tags (ESTs) derived exclusively from retinal cDNA libraries was identified. METHODS: Northern blot and RT-PCR analyses confirmed preferential retinal expression of the gene, which encodes a G protein coupled receptor, GPR75. Following isolation of the full length cDNA and determination of the genomic organisation, the coding sequence of GPR75 was screened for mutations in 535 AMD patients and 252 controls from Germany, the United States, and Italy. Employed methods included single stranded conformational polymorphism (SSCP) analysis, denaturing high performance liquid chromatography (DHPLC), and direct sequencing. RESULTS: Nine different sequence variations were identified in patients and control individuals. Three of these (-30A>C, 150G>A, and 346G>A) likely represent polymorphic variants. Each of six alterations (-4G>A, N78K, P99L, S108T, T135P, and Q234X) were found once in single AMD patients and were considered variants that could affect the protein function and potentially cause retinal pathology. CONCLUSION: The presence of six potential pathogenic variants in a cohort of 535 AMD patients alone does not provide statistically significant evidence for the association of sequence variation in GPR75 with genetic predisposition to AMD. However, a possible connection between the variants and age related retinal pathology cannot be discarded. Functional studies are needed to clarify the role of GPR75 in retinal physiology.

Cardiomyopathy in pregnancy: a retrospective study.

Women with dilated cardiomyopathies (DCM) have traditionally been advised not to attempt to carry pregnancies. This is largely based on data derived from studies of the course of peripartum cardiomyopathy (PPCM) and it is not clear that this extrapolation is appropriate. Our objective was to compare maternal and obstetric outcomes of pregnancies in women with preexisting DCM to women with PPCM. A 10-year retrospective comparative cohort study was undertaken of women between the ages of 15 and 40 discharged from two university medical centers with the diagnosis of cardiomyopathy (CM). Patients were included in the study if CM was diagnosed prior to pregnancy (DCM group) or if CM developed during pregnancy or within 5 months postpartum (PPCM group), and follow-up data was available. Thirty-one subjects were included in the study. Twenty-three women with the diagnosis of PPCM were compared with 8 women with DCM of other etiologies. There were no significant differences in maternal age, race, parity, tobacco or other substance use, or other risk factors between the two groups. Maternal outcomes in the PPCM group were significantly worse than in the DCM group, with three maternal deaths and four women undergoing heart transplants (p = 0.05). In the DCM group, one woman with a prepregnancy ejection fraction of 16% underwent transplantation after termination of pregnancy for genetic indications. None of the other women in the DCM group had a significant decline in cardiac status. Infant outcomes in both groups were uniformly good. PPCM represents an acute, evolving insult to the pregnant or postpartum woman. The prognosis of this condition should not be used for counseling women with DCM considering pregnancy. Women with stable DCM may do well during pregnancy without significant deterioration in their cardiac status.

Ligand-binding characterization of xanthophyll carotenoids to solubilized membrane proteins derived from human retina.

The macula of the human retina contains extraordinarily high concentrations of lutein and zeaxanthin, xanthophyll carotenoids that appear to play an important role in protecting against age-related macular degeneration, the leading cause of blindness among the elderly. It is likely that the uptake and stabilization of these carotenoids is mediated by specific xanthophyll-binding proteins. In order to purify and characterize such a binding protein, a carotenoid-rich membrane fraction derived from human macula or peripheral retina was prepared by homogenization, differential centrifugation, and detergent solubilization. Further purification was carried out using ion-exchange chromatography and gel-filtration chromatography coupled with continuous photodiode-array monitoring for endogenously associated xanthophyll carotenoids. The most highly purified preparations contained two major protein bands at 25 and 55 kDa that consistently co-eluted with endogenous lutein and zeaxanthin. The visible absorbance spectrum of the binding protein preparation closely matches the spectral absorbance of the human macular pigment, and it is bathochromically shifted about 10 nm from the spectrum of lutein and zeaxanthin dissolved in organic solvents. Binding of exogenously added lutein and zeaxanthin is saturable and specific with an apparent Kd of approximately 1 microM. Canthaxanthin and beta-carotene exhibit no significant binding activity to solubilized retinal membrane proteins when assayed under identical conditions. Other potential mammalian xanthophyll-binding proteins such as albumin, tubulin, lactoglobulin and serum lipoproteins possess only weak non-specific binding affinity for carotenoids when assayed under the same stringent binding conditions. This investigation provides the first direct evidence for the existence of specific xanthophyll-binding protein(s) in the vertebrate retina and macula. The possible roles of xanthophyll-binding proteins in normal macular function and in the pathogenesis of age-related macular degeneration remain to be elucidated.

Identification and quantitation of carotenoids and their metabolites in the tissues of the human eye.

There is increasing evidence that the macular pigment carotenoids, lutein and zeaxanthin, may play an important role in the prevention of age-related macular degeneration, cataract, and other blinding disorders. Although it is well known that the retina and lens are enriched in these carotenoids, relatively little is known about carotenoid levels in the uveal tract and in other ocular tissues. Also, the oxidative metabolism and physiological functions of the ocular carotenoids are not fully understood. Thus, we have set out to identify and quantify the complete spectrum of dietary carotenoids and their oxidative metabolites in a systematic manner in all tissues of the human eye in order to gain better insight into their ocular physiology. Human donor eyes were dissected, and carotenoid extracts from ocular tissues [retinal pigment epithelium/choroid (RPE/choroid), macula, peripheral retina, ciliary body, iris, lens, vitreous, cornea, and sclera] were analysed by high-performance liquid chromatography (HPLC). Carotenoids were identified and quantified by comparing their chromatographic and spectral profiles with those of authentic standards. Nearly all ocular structures examined with the exception of vitreous, cornea, and sclera had quantifiable levels of dietary (3R,3'R,6'R)-lutein, zeaxanthin, their geometrical (E / Z) isomers, as well as their metabolites, (3R,3'S,6'R)-lutein (3'-epilutein) and 3-hydroxy-beta,epsilon-caroten-3'-one. In addition, human ciliary body revealed the presence of monohydroxycarotenoids and hydrocarbon carotenoids, while only the latter group was detected in human RPE/choroid. Uveal structures (iris, ciliary body, and RPE/choroid) account for approximately 50% of the eye's total carotenoids and approximately 30% of the lutein and zeaxanthin. In the iris, these pigments are likely to play a role in filtering out phototoxic short-wavelength visible light, while they are more likely to act as antioxidants in the ciliary body. Both mechanisms, light screening and antioxidant, may be operative in the RPE/choroid in addition to a possible function of this tissue in the transport of dihydroxycarotenoids from the circulating blood to the retina. This report lends further support for the critical role of lutein, zeaxanthin, and other ocular carotenoids in protecting the eye from light-induced oxidative damage and aging.

Evaluation of the ELOVL4 gene in patients with age-related macular degeneration.

Stargardt-like macular degeneration (STGD(3)) and autosomal dominant macular degeneration (adMD) share phenotypic characters with atrophic age-related macular degeneration (AMD). Mutations in a photoreceptor cell-specific factor involved in the elongation of very long chain fatty acids (ELOVL(4)) were shown to be associated with STGD(3), adMD, and pattern dystrophy. We screened 778 patients with AMD and 551 age-matched controls to define the role of sequence variants in the ELOVL(4) gene in age-related macular degeneration. We detected three sequence variants in the non-coding region and eight variants in the coding region. No statistically significant association was observed between sequence variants in the ELOVL(4) gene and susceptibility to AMD. However, for the detection of modest effects of multiple alleles in a complex disease, the analysis of larger cohorts of patients may be required.

Resonant Raman detection of macular pigment levels in the living human retina.

We have used resonant Raman scattering as a novel, noninvasive in vivo optical technique to measure the concentration of macular carotenoid pigments in the living human retina. Using a backscattering geometry and resonant molecular excitation in the visible, we measure the Raman peaks that originate from the single- and double-bond stretch vibrations of the p -conjugated molecule's carbon backbone. The Raman signals scale linearly with carotenoid content, whereas the required laser excitation is well under safety limits for macular exposure. The Raman technique is objective and quantitative and may lead to a new method for rapid screening of carotenoid pigment levels in large human populations that are at risk for vision loss from age-related macular degeneration, the leading cause of blindness of the elderly in the United States.

Exophiala werneckii endophthalmitis following cartaract surgery in an immunocompetent individual.

A case of infectious endophthalmitis caused by the saprophyte Exophiala werneckii is reported. This has not been recognized as a pathogen for ocular infections previously. The infection followed uncomplicated cataract surgery involving phacoemulsification and IOL implant. Clinical presentation was that of an indolent endophthalmitis with relatively acute onset. Pars plana vitrectomy, fungal stains, and culture established the diagnosis. Initial management consisted of empirical intravitreal injection of vancomycin, ceftazidime, and amphotericin B. Treatment was supplemented with a 3-week course of systemic fluconazole and topical therapy with natamycin, atropine, ciprofloxacin, and diclofenac. The visual acuity returned to 20/20-2 with no recurrence of infection. The source of the infection could not be determined. Fungal endophthalmitis has to be considered as a rare, though important, complication following ophthalmic surgery. Specific fungal stains and cultures are helpful for establishing the diagnosis early in the course of disease. E werneckii should be considered in the differential diagnosis of fungal endophthalmitis.

Improving preconception care.

OBJECTIVE: To improve the documentation and delivery of preconception care to all women of reproductive age attending an inner city hospital's outpatient gynecology clinic. A secondary goal was to evaluate the knowledge and awareness of providers regarding preconception care. STUDY DESIGN: A preintervention chart review of a convenience sample of non-pregnant women with reproductive potential who attend an inner city hospital gynecology clinic (n = 100) was conducted to evaluate delivery of preconception care. Items screened for included: family planning services, domestic violence, nutrition and medical risk factors, medication use, appropriate counseling and use of referral services. All providers in the clinic were surveyed to assess their knowledge of and attitudes toward preconception care. A two-part intervention was then carried out: (1) a one-hour lecture for all providers, and (2) a standardized preconception care form inserted in all charts. A postintervention chart review of a second convenience sample (n = 100) and repeat provider survey were then conducted to evaluate the effectiveness of the two interventions. RESULTS: Following the two-pronged intervention, there was evidence of improved documentation of the delivery of preconception care. Documentation of screening in almost all categories was significantly improved (P < .05). The greatest improvements were noted in complete screening for medical risk factors (from 15% to 44%), for over-the-counter and prescription medication use (from 10% to 70% and 30% to 77%, respectively), domestic violence (from 10% to 57%) and nutrition (from 9% to 50%). However, provider knowledge of and attitudes toward preconception care were not significantly changed. CONCLUSION: The combination of education about preconception care and insertion of a standardized form into a patient's chart led to a clear improvement in the documentation of preconception care. Given the significance of preconception care, insertion of a standardized form should be considered to help providers complete and appropriate care to their patients.

Risk factor scoring for predicting venous thromboembolism in obstetric patients.

OBJECTIVE: The aim of this study was to develop a risk factor scoring system for the prediction of venous thromboembolism in obstetric patients. STUDY DESIGN: We conducted a retrospective case-control study of all pregnant or postpartum women admitted to the Jack D. Weiler Hospital from 1987 through 1998 with a discharge diagnosis indicating thromboembolism. For each study subject the three women who were delivered immediately before that index patient were selected for the control group. Data collected included the following: history of thrombosis, age, body mass index, previous abdominal surgical procedures, presence of systemic diseases, and blood type. Each patient was assigned a score that was based on the risk factors identified. RESULTS: We identified 21 patients who had sustained thromboembolic events during pregnancy or 6 weeks post partum. Nineteen of the thromboembolic events (90%) were diagnosed during pregnancy, and these cases were distributed throughout gestation-8 (42%) in the first trimester, 2 (10%) in the second trimester, and 9 (48%) in the third trimester. Six (28%) of these patients had pulmonary embolisms. Two cases of postpartum thromboembolic events were documented. Both were cases of pulmonary embolism. There was 1 maternal death. Patients with a score >2 were at significantly increased risk for having a thromboembolism, with an odds ratio of 4.8 (P <.05). The sensitivity, specificity, positive predictive value, and negative predictive value of this cutoff point were 21%, 95%, 57%, and 78%, respectively. CONCLUSION: Obstetric patients with high risk factor scores were at increased risk for thromboembolism.

Nucleated red blood cells in growth-restricted fetuses: associations with short-term neonatal outcome.

OBJECTIVE: To determine the utility of the neonatal nucleated red blood cell (NRBC) count as an independent predictor of short-term perinatal outcome in growth-restricted fetuses. METHODS: Hospital charts of neonates with a discharge diagnosis indicating a birth weight <10th percentile were reviewed for perinatal outcome. We studied all eligible neonates who had a complete blood count on the first day of life. After multiple gestations, anomalous fetuses and diabetic pregnancies were excluded; 73 neonates comprised the study group. Statistical analysis included ANOVA, simple and stepwise regression. RESULTS: Elevated NRBC counts were significantly associated with cesarean section for non-reassuring fetal status, neonatal intensive care unit admission and duration of neonatal intensive care unit stay, respiratory distress and intubation, thrombocytopenia, hyperbilirubinemia, intraventricular hemorrhage and neonatal death. Stepwise regression analysis including gestational age at birth, birth weight and NRBC count demonstrated that in growth-restricted fetuses, NRBC count was the strongest predictor of neonatal intraventricular hemorrhage, neonatal respiratory distress and neonatal death. CONCLUSION: An elevated NRBC count independently predicts adverse perinatal outcome in growth-restricted fetuses.