Nucleated Red Blood Cells: Could They Be Indicator Markers of Illness Severity for Neonatal Intensive Care Unit Patients?

Rozeta Sokou,Andreas G Tsantes,Maria Lampridou,Aikaterini Konstantinidi,Argyrios E Tsantes,Abraham Pouliakis,Nicoletta Iacovidou,Georgios Ioakeimidis

doi:10.3390/children7110197

Abstract

Background: We aimed to assess whether nucleated red blood cells (NRBCs) count could serve as a diagnostic and prognostic biomarker for morbidity and mortality in critically ill neonates. Methods: The association between NRBCs count and neonatal morbidity and mortality was evaluated in an observational cohort of critically ill neonates hospitalized in our neonatal intensive care unit over a period of 69 months. The discriminative ability of NRBCs count as diagnostic and prognostic biomarkers was evaluated by performing the Receiver Operating Characteristics (ROC) curve analysis. Results: Among 467 critically ill neonates included in the study, 45 (9.6%) of them experienced in-hospital mortality. No statistically significant difference was found with regards to NRBCs count between survivors and non-survivors, although the median value for NRBCs was sometimes higher for non-survivors. ROC curve analysis showed that NRBCs is a good discriminator marker for the diagnosis of perinatal hypoxia in neonates with area under the curve (AUC) [AUC 0.710; 95% confidence interval (CI), 0.660–0.759] and predominantly in preterm neonates (AUC 0.921 (95% CI, 0.0849–0.0993)) by using a cut-off value of ≥11.2%, with 80% sensitivity and 88.7% specificity. NRBCs also revealed significant prognostic power for mortality in septic neonates (AUC 0.760 (95% CI, 0.631–0.888)) and especially in preterms with sepsis (AUC 0.816 (95% CI, 0.681–0.951)), with cut-off value ≥ 1%, resulting in 81.6% sensitivity and 78.1% specificity. Conclusion: NRBCs count may be included among the early diagnostic and prognostic markers for sick neonates.

Highlights

Ill neonates constitute a fragile population with very special characteristics compared to children and adults; early diagnosis and management of critical illness are of great importance for their short-term outcome and lifelong prognosis
Our results revealed that nucleated red blood cells (NRBC) could serve, among others, as prognostic and diagnostic markers in this population, especially in preterm neonates
We evaluated the role of NRBCs count in the diagnosis and prognosis of

Summary

Introduction

Ill neonates constitute a fragile population with very special characteristics compared to children and adults; early diagnosis and management of critical illness are of great importance for their short-term outcome and lifelong prognosis. Dysfunction (NEOMOD) score, and Clinical Risk Index for Babies scoring system (CRIB II) [1,2,3,4] These systems aim to achieve early identification of ill neonates with increased risk of morbidity and mortality and may contribute to improved patient care. The management of critically ill newborns such as septic newborns and those with perinatal hypoxia might be improved and more targeted using novel biomarkers, which could help for the detection of the disease within the critical time window. Several studies have reported that elevated NRBCs count correlates with perinatal hypoxia and inflammation severity (sepsis) [6,7,15,16,17]. Our aim was to investigate if the detection of elevated NRBCs count in critically ill neonates could serve as diagnostic and prognostic marker of neonatal morbidity and mortality

Study Design

Participants

Variables’

Statistical Analysis

Results

Discussion