During embryogenesis, production of Neonatal blood occurs in spatially and temporally distinct sites, including the extraembryonic yolk sac, the fetal liver, and the preterm marrow. The development of primitive erythroblasts in the yolk sac is critical for embryonic survival.
Primitive erythroblasts differentiate within the vascular network rather than in the extravascular space and circulate as nucleated cells. Although it is widely assumed that primitive red cells remain nucleated throughout their life span, it is likely that many ultimately enucleate upon terminal differentiation.
Neonatal blood production through life
After 7 weeks’ gestation, hematopoietic progenitors are no longer detected in the yolk sac. The liver serves as the primary source of red cells from the 9th to the 24th week of gestation. Like primitive erythropoiesis in the yolk sac, definitive erythropoiesis in the fetal liver is necessary for continued survival of the embryo.
In contrast to the yolk sac, where hematopoiesis is restricted to maturing primitive erythroid, macrophage, and megakaryocytic cells, hematopoiesis in the fetal liver consists of definitive erythroid, megakaryocyte, and multiple myeloid, as well as lymphoid lineages.
Hematopoietic cells are first seen in the marrow of the 10 to 11 week embryo, and they remain confined to the diaphyseal regions of long bones until 15 weeks’ gestation. Lymphopoiesis is present in the lymph plexuses and the thymus be-ginning at 9 weeks’ gestation.
Yolk sac stem cells were first thought to seed the liver and eventually the marrow. However, later experiments in avian and amphibian embryos indicate that the hematopoietic stem cells that seed the marrow arise within the body of the embryo proper rather than from the yolk sac. The aorta gonad mesonephros (AGM) region generates hematopoietic stem cells that seed the liver and the marrow to provide lifelong hematopoiesis.
Neonatal blood hemoglobin
Hgb Gower (22) is the major hemoglobin in embryos younger than 5 weeks. Hgb F (22) is the major hemoglobin of fetal life. The fetal hemoglobin concentration in Neonatal blood decreases after birth by approximately 3 percent per week and is generally less than 2 to 3 percent of the total hemoglobin by 6 months of age.
Neonatal blood hemoglobin indices
The mean hemoglobin level in cord blood at term is 16.8 g/dL, with 95 percent of the values falling between 13.7 and 20.1 g/dL. The red cells of the newborn are macrocytic, with a mean corpuscular volume (MCV) in excess of 110 fl/cell. The red cell, hemoglobin, and hematocrit values decrease only slightly during the first week, but decline more rapidly in the following 5 to 8 weeks, producing the physiologic anemia of the newborn.
Neonatal blood leukocytes
The absolute number of neutrophils in the blood of term and premature infants is usually greater than that found in older children. Segmented neutrophils are the predominant leukocytes in the first few days after birth. As their number decreases, the lymphocyte becomes the most numerous cell and remains so during the first 4 postnatal years. Phagocytosis of bacteria and latex granules by neutrophils from premature and term infants is normal.
Bactericidal activity varies according to the conditions of testing and the clinical status of the neonates. The platelet counts in term and preterm infants are between 150 and 400 x 109/L (150,000 to 400,000/ L) comparable to adult values.
The absolute number of lymphocytes in the newborn is equivalent to that in older children, with lower values in premature infants at birth. The absolute number of CD 3+ and CD4+ (helper/inducer phenotype) T cell subsets in Neonatal blood is significantly higher than in adults. Humoral (B cell) immunity also develops early in gestation, but it is not fully active until after birth.
The absolute number of CD 3+ and CD4+ (helper/inducer phenotype) T-cell subsets in blood of newborns is significantly higher than in adults. Humoral (B-cell) immunity also develops early in gestation, but it is not fully active until after birth. In the newborn,approximately 15 percent of lymphocytes have immunoglobulin on their surface, with all immunoglobulin (Ig) isotypes represented.
The term newborn has reduced mean plasma levels (<60% of adult levels) of factors II, IX, X, XI, and XII, prekallikrein, and high-molecular-weight kininogen. In contrast, the plasma concentration of factor VIII is similar and von Willebrand factor is increased compared to older children and adults.