Cord Nucleated Red Blood Cell Research Articles

Usefulness of Umbilical Cord Nucleated RBC as a Prognostic Marker of Neonate Born to Pregnancy Induced Hypertension Mother in Resource Limiting Settings

Background: Pregnancy induced hypertension are multi-system disorders of the mother that affect the fetusbecause of utero-placental insufficiency. These neonates may also have a spectrum of hematological changes which may add to the existing morbidity in them. objectives: To correlate cord Nucleated red blood cells and neonatal outcome in Pregnancy induced hypertension.Materials and method: The study was conducted in the Mata Chanan Devi Hospital, Janakpuri, New Delhi. A total of 55 cases and 55 controls of newborns fulfilling the inclusion criteria. The mother’s antenatal records were examined to rule out the Pre-Existing maternal medical illness. History of drug intake and complianceof treatment was recorded. Results: Cord blood nucleated red blood cells was significantly raised inneonates born to PIH mothers (>13 NRBC/100 WBC) compared to normotensive mothers and also hadsignificantly higher incidence of Low birth weight, Hypoglycemia, Respiratory distress and Asphyxia.Conclusion: NRBC count can be used as a simple tool where expertise not available and accordingly can plan the interventions. It is a special boon in a rural care center, where advanced diagnostic modalities are unaffordable or inaccessible. Umbilical cord NRBC count it correlates well with neonatal outcome.

Does the Umbilical Cord Nucleated Red Blood Cellcan Help Predict Intraventricular Hemorrhage

Background: Intraventricular hemorrhage (IVH) is one of the most serious complications of premature deliveries, especially in very low birth weight (VLBW) newborns. The current study compared the number of nucleated red blood cells (NRBCs) in newborns with and without IVH.Methods: This cross-sectional study was carried out on 109 VLBW neonates who were referred to the Neonatal Intensive Care Unit (NICU) Department of Ghaem Hospital in Mashhad, Iran. They were investigated to evaluate the predictive value of cord NRBC in the diagnosis of IVH. To this end, 77 neonates who had normal brain ultrasonographywere assigned to the control group and 32 newborns with IVH were allocated to the case group. The percentage of NRBC per 100 white blood cells was determined by a blood sample. These neonates underwent brain ultrasonography3-5 days after the birth; thereafter, mean NRBC/100 WBC and the absolute number of NRBC swere compared in both groups.Results: In the current study, the mean scores of NRBC/100 WBC and the absolute number of NRBCs in neonates with IVH were obtained as 15.19 and 2272.38/μl. In the group without IVH, these values were reported as 40.95% and 5459.17/μl, respectively (P>0.05). Based on receiver operating characteristic (ROC) curve, the NRBC value does not have a diagnostic value in predicting the incidence of IVH.Conclusion: As illustrated by the obtained results, the number of absolute NRBCs and the percentage of NRBC/100 WBC cannot help to predict the probability of neonatal IVH. Nonetheless, further studies are recommended in this regard.

Significance of cord blood nucleated red blood cell count in pregnancies complicated by preeclampsia as a marker for intra uterine growth restriction

Background: Preeclampsia is a pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation which is typically characterized by hypertension, proteinuria, edema and fetal compromise which is a leading cause of intra uterine growth restriction (IUGR). Elevated nucleated red blood cell (NRBC) count is introduced as a potential marker of intra-uterine growth restriction (IUGR) hence determination of NRBC counts is essentially helpful in predicting short term neurodevelopment outcome. Objective of the study Elevated nucleated red blood cell (NRBC) count is introduced as a potential marker of intra-uterine growth restriction (IUGR) in term babies born to preeclamptic mothersMethods: A cross sectional study conducted in a tertiary care hospital to evaluate the significance of cord blood NRBC count in term neonates born with pregnancy complicated by preeclampsia. It included 60 healthy mothers (control group) and 60 mothers with PIH. Collected data was analysed with SPSS software.Results: The nucleated red blood cell in cord blood of newborns in preeclampsia group was significantly higher than in the control group (p value 0.013). IUGR is significantly higher in PIH group (p value 0.008).Conclusions: From the observed data it is concluded that IUGR is an important cause of perinatal morbidity and mortality. The commonest maternal cause for IUGR was pregnancy induced hypertension. The other contributing factors were anemia, lack of awareness (unregistered, unbooked cases) among mothers, poor maternal nutrition and poor weight gain during pregnancy. Infants of preeclamptic women have higher nucleated red blood cell count at birth than control which means that preeclampsia may produce an erythropoietic response in the fetus. The positive correlation between cord nucleated red blood cell counts in preeclamptic patients and control group indicates that may be the hypoperfused placenta plays a role in this correlation.

Relation between nucleated red blood cell count in umbilical cord and the obstetric and neonatal outcomes in small for gestational age fetuses and with normal Doppler velocimetry of umbilical artery

To analyze the obstetrical and neonatal outcomes of pregnancies with small for gestation age fetuses after 35 weeks based on umbilical cord nucleated red blood cells count (NRBC). NRBC per 100 white blood cells were analyzed in 61 pregnancies with small for gestation age fetuses and normal Doppler findings for the umbilical artery. The pregnancies were assigned to 2 groups: NRBC≥10 (study group, n=18) and NRBC<10 (control group, n=43). Obstetrical and neonatal outcomes were compared between these groups. The χ(2) test or Student's t-test was applied for statistical analysis. The level of significance was set at 5%. The mean ± standard deviation for NRBC per 100 white blood cells was 25.0 ± 13.5 for the study group and 3.9 ± 2.2 for the control group. The NRBC≥10 group and NRBC<10 group were not significantly different in relation to maternal age (24.0 versus 26.0), primiparity (55.8 versus 50%), comorbidities (39.5 versus 55.6%) and gestational age at birth (37.4 versus 37.0 weeks). The NRBC≥10 group showed higher rate of caesarean delivery (83.3 versus 48.8%, p=0.02), fetal distress (60 versus 0%, p<0.001) and pH<7.20 (42.9 versus 11.8%, p<0.001). The birth weight and percentile of birth weight for gestational age were significantly lower on NRBC≥10 group (2,013 versus 2,309 g; p<0.001 and 3.8 versus 5.1; p=0.004; respectively). There was no case described of 5th minute Apgar score below 7. An NRBC higher than 10 per 100 white blood cells in umbilical cord was able to identify higher risk for caesarean delivery, fetal distress and acidosis on birth in small for gestational age fetuses with normal Doppler findings.

Nonreassuring fetal heart rate patterns and nucleated red blood cells in term neonates

The aim of this study was to evaluate the association between nonreassuring fetal heart rate patterns during labor and umbilical cord nucleated red blood cell counts. Nucleated red blood cell data was collected prospectively from 41 singleton term neonates presented with nonreassuring fetal heart rate patterns and/or meconium stained amniotic fluid during labor (study group) and from 45 term neonates without any evidence of nonreassuring fetal status (controls). Umbilical artery pH, blood gases and base excess were also determined to investigate the correlation between independent variables. The median nucleated red blood cells per 100 white blood cells were 13 (range 0-37) in the study group and 8 (range 0-21) in the control group. Stepwise regression analysis have identified meconium stained amniotic fluid (R(2) = 0.15, p < 0.0001) and umbilical artery PO(2) (R(2) = 0.1, p = 0.002) as independent variables associated with elevated NRBC counts in patients with nonreassuring fetal heart rate patterns. Nucleated red blood cells in the cord blood of newborns were found to be elevated in patients with nonreassuring FHR patterns during labor. However, the wide range and the poor correlation of NRBC count with umbilical artery pH and blood gas values limit its clinical utility as a marker for fetal hypoxia.

The combined detection of umbilical cord nucleated red blood cells and lactate: early prediction of neonatal hypoxic ischemic encephalopathy

To establish a simple and quick method that could be used to predict the occurrence of hypoxic ischemic encephalopathy (HIE) as early as possible by investigating the variations of nucleated red blood cells per 100 white blood cell (NRBC/100 WBC) counts and lactate levels in cord blood. In 46 cases of acute fetal distress (AFD) and 54 cases of chronic fetal distress (CFD) neonates we measured the percentage (NRBCs/100 WBC) and lactate in the umbilical blood. Both lactate levels and NRBC/100WBC counts were higher in CFD and AFD groups than in controls (both P<0.01). The numbers of NRBC/100 WBC and the values of lactate in moderate-severe HIE group were higher than in mild-HIE group (P=0.002 and P=0.042, respectively). The combined sensitivity and specificity was 94% and 96% at 15NRBC/100WBC and 4.25 mmol/L level by combined detecting NRBC and lactate to predict HIE. Three infants (including 1 death and 2 survivors) had the highest levels of NRBC/100WBC and lactate in cord blood, and the 2 survivors had the lowest mental development index (MDI) and psychomotor development index (PDI). Combined detection with NRBC/100WBC and lactate allows early prediction of development and severity of HIE. The levels of these parameters are related to the neurodevelopment outcome of HIE infants.

Nucleated Red Blood Cells in Term Fetuses: Reference Values Using an Automated Analyzer

Background: Nucleated red blood cells (NRBCs) are present in small numbers in the cord blood of healthy fetuses at birth. Acute and chronic stimuli, such as fetal hypoxia, cause increased circulating levels of NRBCs. Manual counting is presently the only way to quantify NRBCs, but it is time-consuming and inaccurate. Recently, automated approaches have been developed in order to quantify NRBCs. Objectives: Our aim was to compare manual vs. automated NRBC counting and derive reference values in umbilical cord blood samples from healthy term fetuses. Methods: We analyzed blood samples from 131 healthy term fetuses by the automated approach and calculated reference values of NRBC counts as percentiles. To compare automated NRBC count with manual count we obtained umbilical cord blood samples from 50 further fetuses. Results: Significant positive correlation was obtained between the two methods (r² = 0.988, Bland-Altman plot mean difference NRBCs/100 WBC: –0.590). The median for NRBCs/100 WBC was 3.05 (range 0–11.6) and the median for absolute NRBC counts ×10⁹/l was 0.39 (range 0–1.8). Conclusions: We demonstrate that values obtained with the automated NRBC counting method are comparable to those obtained with the microscopic manual evaluation and give reference values for umbilical cord NRBCs at term that can be used in clinical practice.

Umbilical cord nucleated red blood cell counts: normal values and the effect of labor

To determine the umbilical cord blood nucleated red blood cell (UC-nRBC) count in uncomplicated pregnancies delivered by elective cesarean section or delivered vaginally. A total of 57-term singleton pregnancies were studied: 33 with elective cesarean sections and 24 with vaginal deliveries. UC-nRBC was analyzed for its nucleated red blood cell counts. A logarithmic transformation of the data was used for statistical analysis. The mean+/-standard deviation (s.d.) for nucleated red blood cell per 100 white blood cells (nRBC/100WBC) from the elective cesarean section group was 7.8+/-7.4. The vaginal delivery group had a mean value of 9.3+/-10.5, which was not significantly different. A value of 22 nRBC/100WBC defined the upper 95% confidence limit. The correlation between absolute nRBC and nRBC/100 WBC was 0.97. Although chronic hypoxia is associated with elevated nRBC, the stress of uncomplicated labor does not change the level. This adds credence to its use as a marker for hypoxia preceding labor and delivery.

Do placental sections accurately reflect umbilical cord nucleated red blood cell and white blood cell differential counts?

Objective. Elevated levels of umbilical cord nucleated red blood cells (nRBCs) have been used to assess in utero hypoxia. Although the umbilical nRBC value has been the ‘gold standard’, umbilical blood may not be obtained at delivery. We determined if the levels of nRBCs and white blood cell (WBC) counts in fixed placental sections might serve as a proxy for cord blood values.Study design. Umbilical blood and placenta were collected from 25 deliveries at Harbor-UCLA Medical Center. Umbilical blood and placental sections were analyzed for nRBCs (per 100 WBC) and WBC differential, and compared with the t-test or the Mann–Whitney rank sum test.Results. nRBC counts were equivalent in umbilical cord and placental sections (5 vs. 4/100 WBC). Umbilical lymphocyte and polymorphonuclear leukocyte (PMN) counts were normally distributed, averaging 35 ± 9 and 56 ± 2/100 WBC, respectively. Placental lymphocyte (33 ± 2/100 WBC) and PMN (60 ± 2/100 WBC) counts were equivalent to cord blood values.Conclusion. WBC differentials and nRBC counts are equivalent in umbilical cord blood and processed placental pathology sections. For infants in whom cord blood cell counts are desired though umbilical cord samples are unavailable, fixed placental sections may serve as a proxy.

Do processed, fixed placental sections accurately reflect umbilical cord nucleated red blood cell and differential counts?

Do processed, fixed placental sections accurately reflect umbilical cord nucleated red blood cell and differential counts?

Fine-needle aspiration in the evaluation of nucleated red blood cells in the human placenta

Objective: The purpose of this study was to evaluate the correlation between placental and umbilical cord nucleated red blood cell counts. Study Design: Eighty placentas and their matched umbilical cord blood samples were collected prospectively immediately after delivery. In vitro fine-needle aspiration biopsy specimens were used to obtain placental tissue samples. Nucleated red blood cells were counted by both manual microscopy and flow cytometry. Statistical analysis included Wilcoxon signed rank test and Spearman correlation. Results: The median nucleated red blood cell counts/100 white blood cell counts for manual microscopy in umbilical cord blood; placental samples were 7.5 and 3.0, respectively (P <.0001). The median nucleated red blood cell counts for flow cytometric determination in umbilical cord blood and placental samples were 11.3 and 8.6, respectively (P <.0001). The Spearman correlation between manually counted umbilical cord blood samples and the placental tissue specimens was 0.66 (P <.0001). The Spearman correlation between flow cytometrically counted umbilical cord blood nucleated red blood cell and nucleated red blood cell counts that were obtained from the placenta was statistically significant (r = 0.74, P <.0001). The Spearman correlation between manual microscopy and flow cytometry for umbilical cord samples and their matched placental tissue specimens were 0.80 and 0.58, respectively, with all probability values at <.0001. Conclusion: Previous studies have reported an association between acute and chronic hypoxia and elevated nucleated red blood cells. Our results indicate that in vitro placental nucleated red blood cell counts correlate with umbilical cord nucleated red blood cell counts and suggest that antenatal evaluation of fetal nucleated red blood cells could be achieved by placental fine-needle aspiration biopsy. (Am J Obstet Gynecol 2003;189:155-8.)

Nucleated red blood cells in human fetal scalp capillary blood samples: a feasibility study

Objective: Elevated umbilical cord nucleated red blood cell (NRBC) counts have been suggested as a predictor of adverse perinatal outcome. We sought to evaluate the feasibility of obtaining fetalscalp capillary blood NRBC counts during labor and to assess their correlation with umbilical cord NRBC counts.Methods: Fetal scalp capillary blood specimens were prospectively collected inlaboring patients who underwent scalp sampling because of the presence of an abnormal fetal heart rate pattern. Matched umbilical cord blood samples were collected immediately after birth. Outcome measureswere the feasibility of obtaining fetal scalp NRBC counts and their correlation with umbilical cord NRBC counts.Results: Thirteen term singleton pregnancies formed the study population. In fourpatients, fetal scalp capillary blood sampling was performed twice. Of the attempts to evaluate fetal scalp capillary samples for NRBC counts, 16 out of 17 (94.1%) were successful. The mean fetal scalpcapillary blood NRBC count per 100 white blood cells was 12.6 ± 7.6 (± SD). Umbilical cord mixed, venous and arterial NRBC counts were 15.5 ± 8.8, 13.4 ± 10.7 and 12.6 ±10.7, with p = 0.09, p = 0.59 and p = 0.68, respectively, when compared to the corresponding scalp sample. The Spearman rank correlation between fetal scalp capillary samples and umbilicalcord mixed, venous and arterial NRBC counts were r = 0.86, r = 0.92 and r = 0.95, respectively, with all p values < 0.001.Conclusion: Previous studies have establishedthe clinical utility of umbilical cord NRBC counts. Our study demonstrated that it was possible to obtain NRBC counts from a fetal scalp capillary sample and that these counts correlated highly with umbilicalcord NRBC counts. Future studies are needed to evaluate fetal scalp NRBC counts as a predictor of perinatal outcome.

Association of ABO incompatibility with elevation of nucleated red blood cell counts in term neonates

Objective: Nucleated red blood cells in the circulation in term neonates have been associated with a wide range of pathologic conditions. We sought to examine the relationship between nucleated red blood cells in the circulation of term neonates and maternal-neonatal blood type compatibility. Study Design: We prospectively collected umbilical blood from all live-born neonates delivered at our institution. Venous blood was analyzed for nucleated red blood cells and is reported as the number of nucleated red blood cells per 100 white blood cells. We reviewed maternal and neonatal records for neonates born at ≥37 weeks’ gestation for correlative clinical data. Statistical analysis was performed with the SAS statistical software package (version 6.12; SAS Institute, Inc, Cary, NC). Kruskal-Wallis analysis was used as a nonparametric test. Results: We evaluated 1661 neonates delivered during the study period and found a mean (±SD) of 9.29 ± 18.56 nucleated red blood cells per 100 white blood cells (range, 0-327 nucleated red blood cells per 100 white blood cells). Nucleated red blood cell counts were lower in ABO-compatible maternal-fetal dyads (mean ± SD, 8.29 ± 12.84 nucleated red blood cells per 100 white blood cells; range, 0-216 nucleated red blood cells per 100 white blood cells) than in ABO-incompatible dyads (mean ± SD, 13.16 ± 13.16 nucleated red blood cells per 100 white blood cells; range, 0-327 nucleated red blood cells/100 white blood cells; P =.006). Neonates of mothers with blood groups A and B had significantly lower nucleated red blood cell counts (P <.05). Dyads with maternal type O and neonate type B had significantly higher nucleated red blood cell counts (P <.002). Nonparametric testing determined that type O mother and type B neonate combinations had significantly higher umbilical cord nucleated red blood cell counts (P <.001). Conclusion: Maternal-fetal ABO incompatibility is associated with elevation of nucleated red blood cell count in term neonates. Nucleated red blood cell elevation does not always connote a serious pathologic process, however, because ABO incompatibility usually does not adversely affect neonatal outcome. The clinical significance of an elevated nucleated red blood cell count thus is limited. (Am J Obstet Gynecol 2000;183:1532-6.)