Biol. Neonate 27: 96-101 (1975)
Leukocyte Alkaline Phosphatase in the Newborn E. Sadovsky, D. M atz1, Y.Z. Diamant and W.Z. Polishuk Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem
Key Words. Leukocyte alkaline phosphatase • Neonates • Delivery Abstract. Leukocyte alkaline phosphatase (LAP) activity was studied in 50 women at delivery and in the newborn after delivery. The following findings were observed: (1) the LAP activity of newborns is lower than that of the mothers; (2) significant decrease in the LAP activity has been observed in newborns on the 4th day after delivery; (3) there are no significant differences between newborns from normal and prolonged labor; (4) immediately after delivery the LAP scores of male newborns are lower than those of females, but 4 days later these scores were reversed, and (5) 4 days after delivery, the LAP scores do correlate to the weight of the newborn.
1 This study is part of a thesis in fulfillment of the requirements for the MD degree of D. Matz.
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It has previously been shown that the serum alkaline phosphatase (SAP) of the newborn is lower than that of his mother (12). The SAP of the mother is of placental origin, while that of the newborn is nonplacental (13). The leukocyte alkaline phosphatase (LAP) of the mother and of the newborn are both of nonplacental origin and are influenced by various conditions such as stress, infection, hormones, etc. (8, 9). Estrogens elevate LAP in the nonpregnant and pregnant women (5, 6). The progesterone inhibits the estrogen-induced elevation of LAP in both these conditions. Corticosteroids elevate LAP in nonpregnant women (8) while the same hormone decreases LAP during pregnancy (6). LAP in the newborn is under the influence of his own and his mother’s hormones, which pass through the placenta, as well as by labor’s stress. The type of labor, normal or prolonged, and the condition of the newborn after delivery might have an influence on the newborn’s LAP.
Sadovsky /Matz /Diamant /Polishuk
97
The aim of the present study was to determine LAP activity in the newborn immediately and during the first 4 days after delivery, and to compare it to that of the mother. Materials and Methods LAP activity was studied in 50 pregnant women during delivery, and at term, and in the newborn immediately after delivery, and at the second and fourth day post partum. Peripheral blood smears were taken from the finger of the mothers and from the heel of the newborns. The LAP score was determined after staining the blood films by Kaplow's method (3). 37 of the women had normal deliveries and 13 prolonged labor. Of the infants, 21 were males and 29 females. The Apgar score in 44 infants was 8 -10, in 5 infants 5 8, and one infant less than 5. The infants’ condition during the first 4 days was classified as follows. Good condition: normal infant with normal respiratory patterns. Fair condition: normal infant with mild respiratory difficulties, and who needed slight aid. Poor condition: the fetus with severe respiratory distress who needed treatment in intensive care unit.
Results
Fig. 1. Leukocyte alkaline phosphatase activity of the newborn after delivery (right) as compared to the leukocyte alkaline phosphatase of the mother at delivery (left).
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The average maternal LAP scores, at delivery, compared to those of the newborn are presented in figure 1. Mean LAP of the infants is significantly lower
Sadovsky /Matz /Diamant ¡Polishuk
98
100
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1 90-
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d e liv e r y
Fig. 2. Leukocyte alkaline phosphatase activity of the newborn after delivery.
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Fig. 3. Comparison of the newborns’ leukocyte alkaline phosphatase activity to that of the mothers.
Downloaded by: University of Connecticut 132.174.250.220 - 10/4/2017 4:02:04 PM
S
Leukocyte Alkaline Phosphatase in the Newborn
99
Fig. 4. Leukocyte alkaline phosphatase activity of male as compared to that of the female.
Downloaded by: University of Connecticut 132.174.250.220 - 10/4/2017 4:02:04 PM
than that of the mothers at delivery (p < 0.005). On the 4th day after delivery, a significant decrease was observed as compared to the day of delivery. The LAP activity of the infants during prolonged labor is not significantly lower than that of the infants in normal labor (fig. 2). There was no correlation between the LAP score of the infants and that of the mothers at delivery (fig. 3). Figure 4 shows LAP activity in the male infants as compared to the females. Immediately after delivery the LAP score in the female infants was significantly higher than in the males (p < 0.01). However, 2 -4 days after delivery the male LAP score was higher than the female score (p < 0.05). In figure 5 the LAP score is correlated with infant’s weight. It shows that 2—4 days after delivery the LAP activity is directly related to the weight of the infant. Higher activity of LAP is parallel to higher weight of the infant.
Sadovsky/Matz /Diamant /Polishuk
100
Fig. 5. Leukocyte alkaline phosphatase activity correlated with infant’s weight.
The mean LAP score of the newborn immediately after delivery was 88.5 ± 3.8. This value is lower than that found by O ’K ell (4) and Whitt (10) and higher than that found by Halbrecht and Shabtai (1). The significant decrease in the LAP scores after delivery observed by us is in agreement with the results of Horner (2). The value of the LAP scores in infants born in prolonged labor was lower than that of normal delivery. This result is similar to that obtained in mothers during prolonged delivery (7), and differs from the results of Wolf et al. (11). The activity of LAP in mothers in delivery is higher than that of infants. This finding is confirmed by Horner (2). The higher values of LAP in female infants as compared to males were found also by Wolf et al. (11). There was no correlation between the LAP score and the weight of the infant immediately after delivery, but such correlation was observed during 2 - 4 days after delivery. Halbrecht and Shabtai (1) and O ’Kell (4) also did not find any correlation between the weight of the infant and the
Downloaded by: University of Connecticut 132.174.250.220 - 10/4/2017 4:02:04 PM
Discussion
Leukocyte Alkaline Phosphatase in the Newborn
101
LAP score immediately after delivery. O ’K ell (4) concluded that the value of LAP in newborns is influenced by sex steroids. The decrease in LAP activity post partum is caused by decreased values of blood hormones excreted during the first post partum days.
References
Prof. E. Sadovsky, Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem (Israel)
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1 Halbrecht, I. and Shabtai, F.: LAP activity in pre-term, term and post term infants. Israel J. med. Sci. 8: 1956-1960 (1972). 2 Horner, R.: Personal commun. 3 Kaplow, L.S.: Cytochemistry of leukocyte alkaline phosphatase. Am. J. clin. Path. 39: 439-449 (1963). 4 O ’Kell, R.T.: LAP in the infant. Ann. N.Y. Acad. Sci. 155: 980-984 (1968). 5 Polishuk, IV.Z.; Zuckerman, H., and Diamant, Y.Z.: Alkaline phosphatase activity in leukocytes during menstrual cycle. Fertil Steril. 19: 901-909 (1968). 6 Polishuk, W.Z.; Diamant, Y.Z.; Zuckerman, H., and Sadovsky, E.: Leukocyte alkaline phosphatase in pregnancy and the puerperium. Am. J. Obstet. Gynec. 107: 604-609 (1970). 7 Sadovsky, E.; Metz, D.; Diamant, Y.Z., and Polishuk, W.Z.: Unpublished. 8 Valentine, W.N.; Follette, J.H.; Beck, W.S., and Lawrence, J.S.: Studies on leukocyte alkaline phosphatase activity: relation to stress and pituitary-adrenal activity. J. Lab. clin. Med. 44: 219-228 (1954). 9 Valentine, W.N. and Beck, IV.S.: Biochemical studies on leukocytes. Phosphatase activ ity in health, leukocytosis and myelocitic leukemia. J. Lab. clin. Med. 38: 39-55 (1951). 10 Whitt, J.: Evaluation of a histochemical method for determining leukocyte alkaline phosphatase activity and a discussion of normal values in adults and newborns. Am. J. med. Tech. 29: 168-174 (1963). 11 Wolf, P.L.; Silberberg, B.; Albert, S.: Horowitz, J , and Muehll, E. von der: Histo chemical similarities between newborn and leukemic myeloid cells and their possible significance. J. clin. Path. 22: 458-459 (1969). 12 Zuckerman, H.; Sadovsky, E., and Kallner, B.: Serum alkaline phosphatase in preg nancy and puerperium. Obstet. Gynec., N.Y. 25: 819-824 (1965). 13 Zuckerman, H. and Sadovsky, E.: Thermostable alkaline phosphatase in pregnancy. Israel J. med. Sci. 1: 230-234 (1965).
Leukocyte Alkaline Phosphatase in the Newborn E. Sadovsky, D. M atz1, Y.Z. Diamant and W.Z. Polishuk Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem
Key Words. Leukocyte alkaline phosphatase • Neonates • Delivery Abstract. Leukocyte alkaline phosphatase (LAP) activity was studied in 50 women at delivery and in the newborn after delivery. The following findings were observed: (1) the LAP activity of newborns is lower than that of the mothers; (2) significant decrease in the LAP activity has been observed in newborns on the 4th day after delivery; (3) there are no significant differences between newborns from normal and prolonged labor; (4) immediately after delivery the LAP scores of male newborns are lower than those of females, but 4 days later these scores were reversed, and (5) 4 days after delivery, the LAP scores do correlate to the weight of the newborn.
1 This study is part of a thesis in fulfillment of the requirements for the MD degree of D. Matz.
Downloaded by: University of Connecticut 132.174.250.220 - 10/4/2017 4:02:04 PM
It has previously been shown that the serum alkaline phosphatase (SAP) of the newborn is lower than that of his mother (12). The SAP of the mother is of placental origin, while that of the newborn is nonplacental (13). The leukocyte alkaline phosphatase (LAP) of the mother and of the newborn are both of nonplacental origin and are influenced by various conditions such as stress, infection, hormones, etc. (8, 9). Estrogens elevate LAP in the nonpregnant and pregnant women (5, 6). The progesterone inhibits the estrogen-induced elevation of LAP in both these conditions. Corticosteroids elevate LAP in nonpregnant women (8) while the same hormone decreases LAP during pregnancy (6). LAP in the newborn is under the influence of his own and his mother’s hormones, which pass through the placenta, as well as by labor’s stress. The type of labor, normal or prolonged, and the condition of the newborn after delivery might have an influence on the newborn’s LAP.
Sadovsky /Matz /Diamant /Polishuk
97
The aim of the present study was to determine LAP activity in the newborn immediately and during the first 4 days after delivery, and to compare it to that of the mother. Materials and Methods LAP activity was studied in 50 pregnant women during delivery, and at term, and in the newborn immediately after delivery, and at the second and fourth day post partum. Peripheral blood smears were taken from the finger of the mothers and from the heel of the newborns. The LAP score was determined after staining the blood films by Kaplow's method (3). 37 of the women had normal deliveries and 13 prolonged labor. Of the infants, 21 were males and 29 females. The Apgar score in 44 infants was 8 -10, in 5 infants 5 8, and one infant less than 5. The infants’ condition during the first 4 days was classified as follows. Good condition: normal infant with normal respiratory patterns. Fair condition: normal infant with mild respiratory difficulties, and who needed slight aid. Poor condition: the fetus with severe respiratory distress who needed treatment in intensive care unit.
Results
Fig. 1. Leukocyte alkaline phosphatase activity of the newborn after delivery (right) as compared to the leukocyte alkaline phosphatase of the mother at delivery (left).
Downloaded by: University of Connecticut 132.174.250.220 - 10/4/2017 4:02:04 PM
The average maternal LAP scores, at delivery, compared to those of the newborn are presented in figure 1. Mean LAP of the infants is significantly lower
Sadovsky /Matz /Diamant ¡Polishuk
98
100
N o rm a l la b o r s P ro lo n g e d la b o rs A ll la b o r s
1 90-
T
I
TT
-----------
2
D e liv e ry
A
D ays a fte r
d e liv e r y
Fig. 2. Leukocyte alkaline phosphatase activity of the newborn after delivery.
170 .
160 -
*
150 •
140 •
130 • 120 * 110 -
*
,
•
• > •
1 0 0 -1
• •
•
•
90
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in £
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in
50 -
S $
40 -
z
30 -
c
•*
.
—i
• • •
30
40
M a te rn a l
50
60
70
80
90
100
110
120
130
140
150
160
170
180
190 2 0 0
LA P s c o re
Fig. 3. Comparison of the newborns’ leukocyte alkaline phosphatase activity to that of the mothers.
Downloaded by: University of Connecticut 132.174.250.220 - 10/4/2017 4:02:04 PM
S
Leukocyte Alkaline Phosphatase in the Newborn
99
Fig. 4. Leukocyte alkaline phosphatase activity of male as compared to that of the female.
Downloaded by: University of Connecticut 132.174.250.220 - 10/4/2017 4:02:04 PM
than that of the mothers at delivery (p < 0.005). On the 4th day after delivery, a significant decrease was observed as compared to the day of delivery. The LAP activity of the infants during prolonged labor is not significantly lower than that of the infants in normal labor (fig. 2). There was no correlation between the LAP score of the infants and that of the mothers at delivery (fig. 3). Figure 4 shows LAP activity in the male infants as compared to the females. Immediately after delivery the LAP score in the female infants was significantly higher than in the males (p < 0.01). However, 2 -4 days after delivery the male LAP score was higher than the female score (p < 0.05). In figure 5 the LAP score is correlated with infant’s weight. It shows that 2—4 days after delivery the LAP activity is directly related to the weight of the infant. Higher activity of LAP is parallel to higher weight of the infant.
Sadovsky/Matz /Diamant /Polishuk
100
Fig. 5. Leukocyte alkaline phosphatase activity correlated with infant’s weight.
The mean LAP score of the newborn immediately after delivery was 88.5 ± 3.8. This value is lower than that found by O ’K ell (4) and Whitt (10) and higher than that found by Halbrecht and Shabtai (1). The significant decrease in the LAP scores after delivery observed by us is in agreement with the results of Horner (2). The value of the LAP scores in infants born in prolonged labor was lower than that of normal delivery. This result is similar to that obtained in mothers during prolonged delivery (7), and differs from the results of Wolf et al. (11). The activity of LAP in mothers in delivery is higher than that of infants. This finding is confirmed by Horner (2). The higher values of LAP in female infants as compared to males were found also by Wolf et al. (11). There was no correlation between the LAP score and the weight of the infant immediately after delivery, but such correlation was observed during 2 - 4 days after delivery. Halbrecht and Shabtai (1) and O ’Kell (4) also did not find any correlation between the weight of the infant and the
Downloaded by: University of Connecticut 132.174.250.220 - 10/4/2017 4:02:04 PM
Discussion
Leukocyte Alkaline Phosphatase in the Newborn
101
LAP score immediately after delivery. O ’K ell (4) concluded that the value of LAP in newborns is influenced by sex steroids. The decrease in LAP activity post partum is caused by decreased values of blood hormones excreted during the first post partum days.
References
Prof. E. Sadovsky, Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem (Israel)
Downloaded by: University of Connecticut 132.174.250.220 - 10/4/2017 4:02:04 PM
1 Halbrecht, I. and Shabtai, F.: LAP activity in pre-term, term and post term infants. Israel J. med. Sci. 8: 1956-1960 (1972). 2 Horner, R.: Personal commun. 3 Kaplow, L.S.: Cytochemistry of leukocyte alkaline phosphatase. Am. J. clin. Path. 39: 439-449 (1963). 4 O ’Kell, R.T.: LAP in the infant. Ann. N.Y. Acad. Sci. 155: 980-984 (1968). 5 Polishuk, IV.Z.; Zuckerman, H., and Diamant, Y.Z.: Alkaline phosphatase activity in leukocytes during menstrual cycle. Fertil Steril. 19: 901-909 (1968). 6 Polishuk, W.Z.; Diamant, Y.Z.; Zuckerman, H., and Sadovsky, E.: Leukocyte alkaline phosphatase in pregnancy and the puerperium. Am. J. Obstet. Gynec. 107: 604-609 (1970). 7 Sadovsky, E.; Metz, D.; Diamant, Y.Z., and Polishuk, W.Z.: Unpublished. 8 Valentine, W.N.; Follette, J.H.; Beck, W.S., and Lawrence, J.S.: Studies on leukocyte alkaline phosphatase activity: relation to stress and pituitary-adrenal activity. J. Lab. clin. Med. 44: 219-228 (1954). 9 Valentine, W.N. and Beck, IV.S.: Biochemical studies on leukocytes. Phosphatase activ ity in health, leukocytosis and myelocitic leukemia. J. Lab. clin. Med. 38: 39-55 (1951). 10 Whitt, J.: Evaluation of a histochemical method for determining leukocyte alkaline phosphatase activity and a discussion of normal values in adults and newborns. Am. J. med. Tech. 29: 168-174 (1963). 11 Wolf, P.L.; Silberberg, B.; Albert, S.: Horowitz, J , and Muehll, E. von der: Histo chemical similarities between newborn and leukemic myeloid cells and their possible significance. J. clin. Path. 22: 458-459 (1969). 12 Zuckerman, H.; Sadovsky, E., and Kallner, B.: Serum alkaline phosphatase in preg nancy and puerperium. Obstet. Gynec., N.Y. 25: 819-824 (1965). 13 Zuckerman, H. and Sadovsky, E.: Thermostable alkaline phosphatase in pregnancy. Israel J. med. Sci. 1: 230-234 (1965).
