Early Diagnosis of Perinatal Asphyxia by Nucleated Red Blood Cell Count: A Case-control Study

Article (PDF Available)inArchives of Iranian medicine 13(4):275-81 · July 2010with424 Reads
Source: PubMed
Perinatal asphyxia is a major cause of neurologic morbidity and mortality. The purpose of this study was to investigate variations in nucleated red blood cell (NRBC) count per 100 white blood cells (WBC) and absolute NRBC/mm3 in blood associated with perinatal asphyxia and its relationship to both the severity and short term prognosis of asphyxia. A prospective (case-control) study was undertaken between October 2006 and December 2008, in the Neonatal Intensive Care Unit, Ghaem Hospital, Mashhad, Iran. A total of 91 infants completed the study. Levels of nucleated red blood cell per 100 white blood cells and absolute nucleated red blood cell counts in venous blood were compared for 42 asphyxiated (case group) and 49 normal neonates (control group). These parameters were also related to the severity of asphyxia and clinical outcome. The NRBC/100 WBC and absolute nucleated red blood cell levels in the blood of newborns in the control group were 3.87+/-5.06 and 58.21+/-87.57/mm3, respectively; whereas the corresponding values in the cases were 18.63+/-16.63 and 634.04+/-1002/mm3, respectively (P<0.001). A statistically significant negative correlation existed between nucleated red blood cell level and indicators of the severity of perinatal asphyxia, first minute Apgar score and blood pH (P<0.001), respectively. A positive correlation was demonstrated between these parameters and severity of asphyxia, acidosis, and poor outcome (P<0.05). The NRBC/100 WBC and/or absolute nucleated red blood cell are simple markers for assessment of severity and early outcomes of perinatal asphyxia.

Full-text (PDF)

Available from: Gordon Ferns
    • "A low first minute APGAR score in newborn is also associated with high nucleated RBC level [15]. It has been observed that caesarean delivery for fetal distress, IUGR, oligoamnios, low APGAR scores, and fetal academia (as indicated umbilical arterial pH < 7) were associated with statistically significant increases in nucleated red blood cell counts [16, 17]. "
    [Show abstract] [Hide abstract] ABSTRACT: Objectives. To evaluate the effect of preeclampsia on the cord blood and maternal NRBC count and to correlate NRBC count and neonatal outcome in preeclampsia and control groups. Study Design. This is a prospective case control observational study. Patients and Methods. Maternal and cord blood NRBC counts were studied in 50 preeclamptic women and 50 healthy pregnant women. Using automated cell counter total leucocyte count was obtained and peripheral smear was prepared to obtain NRBC count. Corrected WBC count and NRBC count/100 leucocytes in maternal venous blood and in cord blood were compared between the 2 groups. Results. No significant differences were found in corrected WBC count in maternal and cord blood in cases and controls. Significant differences were found in mean cord blood NRBC count in preeclampsia and control groups (40.0 ± 85.1 and 5.9 ± 6.3, P = 0.006). The mean maternal NRBC count in two groups was 2.4 ± 9.0 and 0.8 ± 1.5, respectively (P = 0.214). Cord blood NRBC count cut off value ≤13 could rule out adverse neonatal outcome with a sensitivity of 63% and specificity of 89%. Conclusion. Cord blood NRBC are significantly raised in preeclampsia. Neonates with elevated cord blood NRBC counts are more likely to have IUGR, low birth weight, neonatal ICU admission, respiratory distress syndrome, and assisted ventilation. Below the count of 13/100 leucocytes, adverse neonatal outcome is quite less likely.
    Full-text · Article · Mar 2014
    • "The normal values of NRBCs/100 WBCs have been given by different authors by various studies conducted over the years. Shivhare et al [16], Sinha et al [17], Phelan et al [18] and Hanlon-Lundberg et al [19] [15] where only 8% babies and Boskabadi et al (2010) [7] where only 14.28% of babies did not develop HIE. Similarly 12.86% of our babies developed stage III HIE which is comparable to a study by Shivaprakash et al (2013) [15] where 12% babies developed stage III HIE.Table 9 shows the comparison of NRBC with stages of HIE in various studies. "
    Article · Jan 2014 · Journal of Perinatal Medicine
    • "Indeed, an abnormal NRBC count at birth is associated more strongly with short-term neonatal outcome (requirement of mechanical ventilation, need for vasopressure agents or neonatal mortality) than birth weight or gestational age regardless of being small or appropriate for gestational age [119]. An increased NRBC count has been associated with chronic intrauterine hypoxia or stress130131132133134135136137138, frequently seen in fetuses of mothers with preeclampsia [121,139140141, intrauterine growth restriction [116,119120121 or diabetes mellitus142143144. However, an experimental study indicates that the administration of recombinant IL-6 to animals can stimulate the erythroid progenitor cells in the bone marrow and eventually lead to the release of NRBC into circulation, suggesting that inflammation can trigger systemic elevation of NRBC count [145]. "
    [Show abstract] [Hide abstract] ABSTRACT: The fetal inflammatory response syndrome (FIRS) is associated with impending onset of preterm labor/delivery, microbial invasion of the amniotic cavity and increased perinatal morbidity. FIRS has been defined by an elevated fetal plasma interleukin (IL)-6, a cytokine with potent effects on the differentiation and proliferation of hematopoietic precursors. The objective of this study was to characterize the hematologic profile of fetuses with FIRS. Fetal blood sampling was performed in patients with preterm prelabor rupture of membranes and preterm labor with intact membranes (n=152). A fetal plasma IL-6 concentration ≥ 11 pg/mL was used to define FIRS. Hemoglobin concentration, platelet count, total white blood cell (WBC) count, differential count, and nucleated red blood cell (NRBC) count were obtained. Since blood cell count varies with gestational age, the observed values were corrected for fetal age by calculating a ratio between the observed and expected mean value for gestational age. 1) The prevalence of FIRS was 28.9% (44/152); 2) fetuses with FIRS had a higher median corrected WBC and corrected neutrophil count than those without FIRS (WBC: median 1.4, range 0.3-5.6, vs. median 1.1, range 0.4-2.9, P=0.001; neutrophils: median 3.6, range 0.1-57.5, vs. median 1.8, range 0.2-13.9, P<0.001); 3) neutrophilia (defined as a neutrophil count >95th centile of gestational age) was significantly more common in fetuses with FIRS than in those without FIRS (71%, 30/42, vs. 35%, 37/105; P<0.001); 4) more than two-thirds of fetuses with FIRS had neutrophilia, whereas neutropenia was present in only 4.8% (2/42); 5) FIRS was not associated with detectable changes in hemoglobin concentration, platelet, lymphocyte, monocyte, basophil or eosinophil counts; and 6) fetuses with FIRS had a median corrected NRBC count higher than those without FIRS. However, the difference did not reach statistical significance (NRBC median 0.07, range 0-1.3, vs. median 0.04, range 0-2.3, P=0.06). The hematologic profile of the human fetus with FIRS is characterized by significant changes in the total WBC and neutrophil counts. The NRBC count in fetuses with FIRS tends to be higher than fetuses without FIRS.
    Full-text · Article · Sep 2011
Show more