Study of nucleated RBC count as a marker of severity of perinatal asphyxia in newborns - a case control study

Abstract

Introduction: This study was done to estimate the nucleated red blood cell count (NRBCs) in normal and asphyxiated babies and find their correlation with severity of birth asphyxia. Materials and Methods: About 50 normal newborns as control and 50 newborns with perinatal asphyxia as cases were considered. At birth 2 mL of venous blood was collected in both cases and control groups. nRBC count per 100 white blood cells (WBC) was done at admission. Clinical assessments in terms of neurologic status at birth, 24 hours after birth and every day thereafter till discharge/death was done. Cord blood nRBC/100 WBC was correlated with stages of HIE during hospital stay. Neonates were monitored for adverse outcome such as tone abnormalities, feeding difficulty, refractory seizures and death. Controls were followed up in the same manner. Results: Among 50 cases, 24 had no hypoxic ischaemic encephalopathy (HIE),17 had stage 1 HIE, 6 had stage 2 and 3 newborns had stage 3 HIE. The mean APGAR score in cases was 5.34 ± 1.19 where as for the control group it was 8.12 ± 0.77 with p value of 0.001 which is statistically significant. The mean nRBC in newborns with APGAR score of 3, 4,5, 6 were 35.5, 19.9, 20.6 and 12 respectively. The low APGAR scores showed high nRBCs. Mean nRBCs for HIE stage 1, 2, 3 was 19.1, 31.0, and 54.3 respectively. High nRBC count correlated with increasing severity of birth asphyxia. Conclusion: nRBC count is an easy, simple and a reliable test to assess the severity of birth asphyxia in resource poor settings.