Article Data

  • Views 1613
  • Dowloads 128

Original Research

Open Access

Leukocytes influence peripheral tissue oxygenation and perfusion in neonates


1,Department of Paediatrics Medical University of Graz

2,Institute for Medical Informatics Statistics and Documentation Medical University of Graz

DOI: 10.22514/SV82.102013.3 Vol.8,Issue 2,October 2013 pp.20-23

Published: 17 October 2013

*Corresponding Author(s): GERHARD PICHLER E-mail:


Background. Leukocyte counts may influence peripheral (micro) circulation due to changes in rheology. The aim of this study was to investigate a possible association between leukocyte counts and peripheral tissue oxygenation/perfusion measured with near infrared spectroscopy (NIRS) in term and preterm neonates.

Methods. In this observational study we included term and preterm neonates within the first 2 months of life, in whom perip-heral tissue NIRS measurements were performed and blood samples (leukocytes and C reactive protein (CRP)) taken to investigate clinical signs of infection. Tissue-oxygenation index (TOI), fractional oxygen extraction (FTEO), oxygen delivery 

(DO2), oxygen consumption (VO2) and vascular resistance (VR) were measured by NIRS and venous occlusion method. TOI, FTOE, DO2, VO2 and VR were correlated to leukocyte counts on the same day and maximal CRP levels within 24 hours (CRP max).

Results. In 180 infants, with a mean gestational age of 35.5±3.3 weeks, leukocyte counts were 16546± 8830/􀀁l (median 14830; range 1790 to 67840) and CRP max was 8.0± 19.0 mg/l (median 0.0; range 0.0 to 110.0mg/l).

TOI was 71.1±5.5%, FTOE 28.5±6.1%, DO2 46.7±19.7, VO2 12.5±4.4 and VR 11.7±6.4.

Leukocyte counts correlated negatively (r= -0.21; p= 0.005) with TOI and positively (r=0.17; p=0.029) with VR. Correlations with CRP max did not reach significance.

Conclusion. We demonstrated that peripheral tissue oxygen consumption decreases and vascular resistance increases with increasing leukocyte counts.


near-infrared spectros-copy, neonate, microcirculation, leu-kocytes

Cite and Share

CORINNA BINDER,BERNDT URLESBERGER,REGINA RIEDL,NICHOLAS MORRIS,BERNHARD SCHWABERGER,GERHARD PICHLER. Leukocytes influence peripheral tissue oxygenation and perfusion in neonates. Signa Vitae. 2013. 8(2);20-23.


1. Braide M, Amundson B, Chien S, Bagge U. Quantitative studies on the influence of leukocytes on the vascular resistance in a skeletal muscle preparation. Microvasc Res 1984;27:331-52.

2. Norman M, Fagrell B, Herin P. Skin microcirculation in neonatal polycythaemia and effects of haemodilution. Interaction between haema-tocrit, vasomotor activity and perfusion. Acta Paediatr 1993;82:672-7.

3. Stark MJ, Clifton VL, Wright IM. Microvascular flow, clinical illness severity and cardiovascular function in the preterm infant. Arch Dis Child Fetal Neonatal Ed 2008; 93:F271-4.

4. Top AP, Tasker RC, Ince C. The microcirculation of the critically ill pediatric patient. Crit Care 2011;15:213.

5. Ince C. The microcirculation is the motor of sepsis. Crit Care 2005; 9 Suppl 4:S13-9.

6. Stefanovic IM. Neonatal sepsis. Biochem Med 2011;21:276-81.

7. Caldas JP, Marba ST, Blotta MH, Calil R, Morais SS, Oliveira RT. Accuracy of white blood cell count, C-reactive protein, interleukin-6 and tumor necrosis factor alpha for diagnosing late neonatal sepsis. J Pediatr (Rio J) 2008;84:536-42.

8. Lima A, Bakker J. Noninvasive monitoring of peripheral perfusion. Intensive Care Med 2005;31:1316-26.

9. Wolf M, Ferrari M, Quaresima V. Progress of near-infrared spectroscopy and topography for brain and muscle clinical applications. J Biomed Opt 2007;12:62104.

10. Weindling AM. Peripheral oxygenation and management in the perinatal period. Semin Fetal Neonatal Med 2010;15:208-15.

11. De BRA, Palmisani S, Alampi D, Mercieri M, Romano R, Collini S, et al. Microvascular dysfunction and skeletal muscle oxygenation asses-sed by phase-modulation near-infrared spectroscopy in patients with septic shock. Intensive Care Med 2005;31:1661-8.

12. Kullo IJ, Khaleghi M, Hensrud DD. Markers of inflammation are inversely associated with VO2 max in asymptomatic men. J Appl Physiol 2007;102:1374-9.

13. Nanas S, Gerovasili V, Renieris P, Angelopoulos E, Poriazi M, Kritikos K, et al. Non-invasive assessment of the microcirculation in critically ill patients. Anaesth Intensive Care 2009;37:733-9.

14. Pichler G, Pocivalnik M, Riedl R, Pichler-Stachl E, Zotter H, Müller W, et al. C reactive protein: impact on peripheral tissue oxygenation and perfusion in neonates. Arch Dis Child Fetal Neonatal Ed 2012; doi:10.1136/archdischild-2011-300578.

15. Duncan A, Meek JH, Clemence M, Elwell CE, Tyszczuk L, Cope M, et al. Optical pathlength measurements on adult head, calf and forearm and the head of the newborn infant using phase resolved optical spectroscopy. Phys Med Biol 1995;40:295-304.

16. Pichler G, Grossauer K, Peichl E, Gaster A, Berghold A, Schwantzer G, et al. Combination of different noninvasive measuring techniques: a new approach to increase accuracy of peripheral near infrared spectroscopy. J Biomed Opt 2009;14:14014.

17. Miller ME, Myers K. Cellular deformability of the human peripheral blood polymorphonuclear leukocyte: method of study, normal variation and effects of physical and chemical alterations. J Reticuloendothel Soc 1975;18:337-45.

18. Pichler G, Pocivalnik M, Riedl R, Pichler-Stachl E, Morris N, Zotter H, et al. ‘Multi-associations’: predisposed to misinterpretation of peri-pheral tissue oxygenation and circulation in neonates. Physiol Meas 2011;32:1025-34.

19. Wardle SP, Yoxall CW, Crawley E, Weindling AM. Peripheral oxygenation and anemia in preterm babies. Pediatr Res 1998;44:125-31.

20. Kissack CM, Weindling AM. Peripheral blood flow and oxygen extraction in the sick, newborn very low birth weight infant shortly after birth. Pediatr Res 2009;65:462-7.

21. Bateman RM, Sharpe MD, Ellis CG. Bench-to-bedside review: microvascular dysfunction in sepsis--hemodynamics, oxygen transport, and nitric oxide. Crit Care 2003;7:359-73.

22. Yodice PC, Astiz ME, Kurian BM, Lin RY, Rackow EC. Neutrophil rheologic changes in septic shock. Am J Respir Crit Care Med 1997;155:38-42.

23. Nishino M, Tanaka H, Ogura H, Inoue Y, Koh T, Fujita K, et al. Serial changes in leukocyte deformability and whole blood rheology in patients with sepsis or trauma. J Trauma 2005;59:1425-31.

24. Haslett C, Worthen GS, Giclas PC, Morrison DC, Henson JE, Henson PM. The pulmonary vascular sequestration of neutrophils in endo-toxemia is initiated by an effect of endotoxin on the neutrophil in the rabbit. Am Rev Respir Dis 1987;136:9-18.

25. Worthen GS, Schwab B3, Elson EL, Downey GP. Mechanics of stimulated neutrophils: cell stiffening induces retention in capillaries. Scien-ce 1989;245:183-6.

26. Hassan IA, Wickramasinghe YA, Spencer SA. Effect of a change in global metabolic rate on peripheral oxygen consumption in neonates. Arch Dis Child Fetal Neonatal Ed 2003; 88:F143-6.

27. Hassan IA, Wickramasinghe YA, Spencer SA. Effect of limb cooling on peripheral and global oxygen consumption in neonates. Arch Dis Child Fetal Neonatal Ed 2003;88:F139-42.

28. Victor S, Marson AG, Appleton RE, Beirne M, Weindling AM. Relationship between blood pressure, cerebral electrical activity, cerebral fractional oxygen extraction, and peripheral blood flow in very low birth weight newborn infants. Pediatr Res 2006; 59:314-9.

29. Wardle SP, Yoxall CW, Weindling AM. Peripheral oxygenation in hypotensive preterm babies. Pediatr Res 1999;45:343-9.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time