Introduction
The complete blood count (CBC) is an essential diagnostic tool in neonatal care that provides crucial data for the effective management of newborns. The values obtained from CBC can fluctuate during pregnancy due to a myriad of factors including maternal health, environmental influences, and nutritional status, in addition to the maturity level of the newborns. Premature infants, born before 37 completed weeks of gestation, represent a particularly vulnerable group, often facing a range of hematological, infectious, and neurodevelopmental complications. In Morocco, the prevalence of preterm births is concerning, with an incidence rate estimated between 3% and 8%, which highlights the urgent need for a deeper understanding of their hematological profiles to facilitate timely diagnosis and management of potential health issues.
The phenomenon of preterm birth is recognized as a leading contributor to neonatal morbidity and mortality worldwide. Research indicates that approximately 13.4 million preterm births occurred globally in 2020, accounting for around 10% of all live births. This issue is compounded in low- and middle-income countries, including Morocco, where the rates are alarmingly higher. Preterm neonates typically exhibit distinct hematological characteristics that arise from the immaturity of their hematopoietic organs and the abrupt cessation of placental support. At birth, these infants experience significant alterations in their blood parameters, such as an increase in mean corpuscular volume (MCV) linked to the prevalence of fetal hemoglobin, alongside variable leukocyte counts and thrombocytopenia, particularly among those born extremely prematurely. These hematological irregularities have direct clinical implications, leading to heightened transfusion needs, increased vulnerability to hospital-acquired infections, and a greater risk of intraventricular hemorrhage.
While reference hematological values for preterm infants have been established through extensive studies in various global populations, including North America and Europe, there remains a notable gap in localized data for preterm neonates in Morocco, especially in the Eastern region. The absence of region-specific reference ranges can result in misinterpretations of CBC results, potentially leading to unnecessary treatments or delays in identifying genuine hematological disorders. This gap is particularly troubling considering the established impact of maternal nutrition and the quality of prenatal care on fetal hematopoiesis in similar populations within the Maghreb region. Therefore, this study seeks to elucidate the hematological profiles of non-infected preterm neonates within this specific setting and draw comparisons with international reference data.
Materials & Methods
This retrospective descriptive study was conducted by reviewing the medical records of preterm neonates admitted to the Neonatology and Neonatal Intensive Care Unit at Mohammed VI University Hospital, a tertiary care facility in the Oriental region of Morocco. The research spanned a 12-month period from January 1 to December 31, 2023. Inclusion criteria encompassed all preterm neonates born at less than 37 weeks gestation, confirmed through obstetric ultrasound or clinical scoring, who were admitted within the first 72 hours of life and showed no clinical or biological signs of infection at the time of sampling. Conversely, neonates with confirmed infections, significant perinatal complications, congenital anomalies, or incomplete medical records were excluded from the analysis.
During the study, a total of 192 preterm neonates were admitted, with 167 (86.9%) admitted within the first 72 hours. After applying the exclusion criteria, 112 non-infected preterm neonates were selected for final analysis, categorized into three gestational age subgroups: extremely preterm (EP, <28 weeks), very preterm (VP, 28-31 weeks), and moderate preterm (MP, 32-36 weeks). Data were collected retrospectively from patient records using standardized forms, capturing variables such as gestational age, birth weight, sex, delivery mode, maternal age, comorbidities, and exposure to antenatal corticosteroids. Blood samples were obtained following standard protocols, with CBC analyses performed using an automated hematology analyzer.
The primary objective was to delineate and compare hematological parameters, including white blood cell (WBC) counts, neutrophil counts, hemoglobin levels, and platelet counts across the three gestational age groups. Statistical analysis was conducted using SPSS Statistics, employing non-parametric tests due to the non-normal distribution of most parameters, with a significance threshold set at p < 0.05.
This study aims to fill the existing knowledge gap regarding the hematological profiles of preterm neonates in Morocco, providing critical insights that could inform clinical practices and improve outcomes for this vulnerable population. As reported by cureus.com.
