Nucleated Red Blood cells as a Marker of Perinatal Hypoxic Events in Neonates
Journal Title: The Indian Journal of Maternal-Fetal and Neonatal Medicine - Year 2017, Vol 4, Issue 2
Abstract
Objectives: To correlate nucleated RBC count per 100 WBC (nRBC/ 100WBC) within first 24 hours of birth in term and near term neonates with perinatal hypoxic events and to correlate increased nRBC/100WBC with adverse prognostic outcome in neonates. Design: Prospective comparative study. Setting: Level III neonatal intensive care unit (NICU) of tertiary care hospital in southern India. Participants: 128 neonates e— 34 weeks of gestation admitted in NICU over 10 months period. Methods: Neonates were grouped into twoperinatal hypoxic and controls. Details regarding birth weight, gestational age, maternal age, relevant antenatal history and mode of delivery was obtained. Examination included Apgar score at birth and assessment for need for any respiratory support. Blood gas estimation from umbilical cord blood at birth and peripheral smear examination for nRBC/100WBC within first 24 hours of birth was done. Morbidity in form of duration of NICU stay was evaluated. Result: Among 128 babies, 46 had perinatal hypoxia while 82 acted as control. Mean nRBCs/100WBC among the cases was 15.54±63.66 whereas that in control was 3.74±5.21. Among the term babies, mean nRBC/100 WBC was significantly higher in those with perinatal hypoxia (17.28±69.09) as compared to controls (3.15±4.418). Statistically significant association was observed between mean nRBC/100WBC and gestational age at birth, requirement of resuscitation at birth and duration of NICU stay. On constructing receiver operating characteristics curve, among term babies for nRBC/100 WBC of >2, sensitivity and specificity was 66.67% and 64.15% respectively, with a positive and negative predictive value of 57.77% and 72.34% respectively. The specificity increased to 95% when a cut off > 13 nRBC/100 WBC was used. Conclusion: Among term babies, mean nRBC/100WBC was significantly higher in those with perinatal hypoxia as compared to controls. Hence raised nRBC/100WBC at Day 1 of life in term babies can be taken as surrogate marker of perinatal hypoxic event provided confounding factors have been eliminated. Higher mean nRBC/100WBC on Day 1 of life can be used as a predictor of morbidity and hence longer duration of NICU stay.
Authors and Affiliations
Deena Thomas
Keywords
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- EP ID EP454688
- DOI 10.21088/ijmfnm.2347.999X.4217.6
- Views 106
- Downloads 0
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