Neonatal Neutropenias

1. Sick or septic newborns, including premature infants. Newborns have fewer mature neutrophils and neutrophil precursors per kilogram. Sick newborns are slow to upregulate the number of circulating neutrophils during infection.

2. Alloimmune neutropenia of newborn. Neonatal neutropenia caused by maternal antibodies against paternal WBC antigens. Analogous to neonatal anemia caused by Rh incompatibility; 40% of mothers have had miscarriages. Maternal antibodies are most commonly generated to paternal WBC antigens NA1 and NA2. Associated with fevers and serious infections (eg, pneumonia or omphalitis).

3. Neonatal autoimmune neutropenia. Occurs in infants of mothers with autoimmune neutropenia as a result of passive transfer of ANA from mother to child. Profound neutropenia can last 2-4 weeks.

4. Autoimmune neutropenia of infancy. Similar to idiopathic throm-bocytopenic purpura or autoimmune hemolytic anemia. Acquired disorder, unrelated to maternal or paternal antigen incompatibility. Typically seen at 3-30 months of age. Clinically mild disorder; probably many cases are undiagnosed. Median duration of illness is 2 years, and 95% of patients recover by age 4.

5. Infants of preeclamptic mothers. Half of these infants have neutropenia (up to 80% if intrauterine growth retardation is present).

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