Nucleated Red Blood Cell Counts Research Articles

Nucleated red blood cell levels in the diagnosis of patients with indirect hyperbilirubinemia.

Nucleated red blood cells (NRBCs) are progenitores of red blood cells that are physiologically seen in the peripheral blood of the fetus and newborn at birth. The increased numbers of NRBCs in the circulation is associated with pathologic conditions such as prematurity, hemolytic diseases and bleeding, intrauterine growth restriction. We aimed to evaluate the relationship between NRBCs and the demographic and clinical characteristics of the patients with indirect hyperbilirubinemia who were followed up in the neonatal intensive care unit. In this retrospective study we evaluated 134 patients with indirect hyperbilirubinemia between January 2017 and December 2018. Patients were divided into two groups as those with ABO and/or Rh incompatibility and those without. Groups were compared in terms of demographic, clinical characteristics and for the hematological parameters. A total of 134 infants were evaluated in the study, including 68 (50%) infants with ABO incompatibility, 12 (8.9%) with Rh incompatibility and 3 (2.2%) with ABO and Rh incompatibility. Coombs test results were positive for 34 patients. There were no differences between ABO and/or Rh incompatibility group and non incompatibility group with regards to birth weight, gestational age and gender. In terms of hematologic parameters, there were no differences between the hemoglobin, hematocrit and mean platelet volumes of the patients at the time of hospitalization, while red cell distribution width, NRBCs per 100 white blood cells (NRBCs/100 WBCs) and absolute NRBC count were statistically higher in patients with ABO and/or Rh incompatibility. It was found that NRBCs/100 WBC and absolute NRBC count were statistically higher in patients with positive direct coombs test than patients with negative coombs test (p <0.05). Early diagnosis of indirect hyperbilirubinemia is essential, as it can prevent to occur serious neurological sequelas. Elevated levels of NRBCs in infants with blood group incompatibilities could alert clinicians about the severity of jaundice and should increase awareness in terms of hemolysis.

Study of perinatal asphyxia and its outcome concerning nucleated RBC count in venous blood of term neonates

Introduction: Perinatal asphyxia is a serious problem globally and is one of the common causes ofneonatal mortality. Worldwide each year four million infants suffer from birth asphyxia. Of these onemillion die and an equal number develop serious sequelae. Perinatal asphyxia ranks as the secondmost important cause of neonatal death after infections accounting for about 23% of mortalityworldwide. Aim &amp; objective: To establish the level of nucleated red blood cells as an indicator ofpoor immediate outcome in perinatal asphyxia. Method: It was a case-control study done in thedepartment of pediatrics, S C B Medical College &amp; S V P PG I P, Cuttack. Observation: The NRBCcount was significantly higher in neonates with adverse outcomes than in those with favourableoutcomes (p-value &lt;0.001). NRBC count cut-off of &gt;27/100 WBC had a sensitivity of 75% andspecificity of 95.2% in predicting adverse outcome defined as death, hemiplegia, hypertonia orsignificant hypotonia, unreliable sucking and seizures resistant to Phenobarbital. Conclusion:Nucleated red blood cell count can be used as a surrogate marker for birth asphyxia. It has asignificant negative correlation with Apgar score at one minute and Apgar score at 5minutes &amp;significant positive correlation with severity of hypoxic ischemic-encephalopathy, time is taken forrecovery of neurological impairment following birth asphyxia and duration of NICU stay.

Clinical study of diagnostic efficacy of nucleated red blood cell count (NRBCc) in the early diagnosis of neonatal sepsis

Clinical study of diagnostic efficacy of nucleated red blood cell count (NRBCc) in the early diagnosis of neonatal sepsis

Simple Predictors of Peripheral Blood Stem Cell Yield in Healthy Donors

BACKGROUND: Peripheral blood stem cells (PBSCs) are commonly used for hematopoietic stem cell transplant (HSCT) over other stem cell sources. The hematopoietic stem cells (HSCs) are mobilized from marrow by granulocyte colony-stimulating factor (G-CSF) and then harvested by apheresis technique. The HSC yield differs in donors that may be due to inadequate mobilization or difficulty in harvesting the mobilized stem cells. MATERIALS AND METHODS: We retrospectively analyzed donor demographic and pre-apheresis hematological variables with circulating CD34+ cell (cir CD34) count and HSC yield in product in 100 normal donors. G-CSF was given for 5 consecutive days, and the stem cells were harvested on day 5. The cir CD34 count and pre-apheresis variables were recorded a day before harvest. RESULTS: Of 100 donors, 77% were males and 23% were females. Male sex, younger age, and donor weight were significantly associated with better CD34 yield in the product. Among the pre-apheresis hematological variables, absolute neutrophil count, hematocrit, and absolute nucleated red blood cell count significantly correlated with post-GCF circulating CD34 and CD34 yield in the product. Donors with mean corpuscular volume &lt;80 fL showed relatively poor CD34 cell harvest as compared to normal donors, though with adequate mobilization. CONCLUSION: Selection of donors for PBSC apheresis is crucial for a good transplant outcome and recovery. Alternate strategies that improve the final CD34 yield should be employed for donors with high risk for poor CD34+ cell yield.

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

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.

Correlation of nucleated red blood cell count with neonatal intensive care unit admission

Background: Perinatal asphyxia should be diagnosed, when baby goes on to develop hypoxic ischemic encephalopathy which has shown to be much more reliable indicator of long term handicap than any other perinatal markers like non reassuring FHR, Apgar score, meconium stained amniotic fluid and blood acid base status of fetus. Since NRBC is related to hematopoietic response to hypoxia it predicts the chance of neurological sequelae and NICU admission. The aim of our study to analyze the significant relationship of NRBC count and NICU admission.Methods: This was a retrospective comparative study conducted in department of OBG, Patna medical college and Hospital between December 2013 to November 2015 in tertiary care health centre. Umbilical cord blood samples were collected from 100 newborns with asphyxia at birth out of which 56 were admitted in NICU taken as study group and rest 44 asphyxiated babies were not admitted in NICU were taken as control group. NRBC per 100 WBC was counted in Cord blood sample from all babies.Results: This shows that average count of NRBC/100 WBC in the study with NICU admission was 27.37+7.25. Average count in the study group with no NICU admission was 23.93+6.04. The difference was statistically significant (p&lt;0.05).Conclusions: This study concludes that NRBC count correlate well with fetal asphyxia and finally NICU admission. Early detection leads to decrease neurological morbidity and mortality among survivors.

Evaluation of diagnostic value of nucleated red blood cell count in the early neonatal sepsis

Objective 1. To Evaluate diagnostic value of Nucleated Red blood cell count in the early diagnosis of neonatal sepsis. 2. To compare and correlate raised Nrbcs with blood culture in diagnosis of neonatal sepsis. Material and Method: A prospective study was conducted from January2017 to January 2019, in a Tertiary care private Hospital of 120 neonatses neonates with predisposing perinatal risk factors or if there was clinical suspicion of sepsis. Peripheral Blood smears were examined for haematological parameters along with NRBCS count. The data collected was statistically analyzed, to find out the performance of the test individually and in comparison to gold standard that is blood culture under the following parameters. Sensitivity, specificity, positive predictive value and negative predictive value. Results: Presence of Nrbcs in peripheral smears of culture positive sepsis noted in 82.14% cases. Sensitivity of Nrbcs is 78.57%. Specificity is 89.13%, Positive predictive value 68.75%, Negative predictive value 93.18%. Conclusion: Nrbcs is a single, quick, cost-effective and readily available, feasible tool with good sensitivity and specificity in the early diagnosis of neonatal sepsis. It gives comparable results to blood culture and can be done even in small hospitals and in peripheral setups, allowing prompt treatment of infected neonates and thereby reducing morbidity and mortality.

Association of nucleated red blood cell count with mortality among neonatal intensive care unit patients

Nucleated red blood cells (nRBCs) are associated with adverse outcomes for pediatric and adult intensive care patients. The association between nRBC count and mortality was examined in an observational cohort of patients admitted to the neonatal intensive care unit from December 2015-December 2018. Among the 1059 patients with at least one nRBC count obtained, 45 infants (4.2%) experienced in-hospital mortality prior to NICU discharge, the primary outcome measured in this study. Infants with any nRBC count >0 had a significantly higher risk of mortality (5.3% [45/849] vs. 0% [0/351], p<0.001 by Fisher exact), and time to mortality decreased with higher nRBC counts (Spearman correlation -0.59, p<0.001). The association between nRBC count and mortality remained significant even when restricting only to infants who were older than 7 days at time of nRBC count. Among neonatal intensive care unit patients, including those >7 days old, nRBCs are associated with significantly elevated mortality risk. A prospective study to better characterize clinical co-variants is necessary to better establish the use of nRBCs as a predictor of mortality.

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.

Clinical significance of nucleated red blood cell count in pediatric patients with transfusion-dependent beta thalassemia

Objectives The aim of this study was to assess the count of nucleated red blood cells (NRBCs) as a potential marker of erythropoietic stress and transfusion therapy adequacy. To achieve this goal, we evaluated the performance of the Sysmex XN-1000 hematology analyzer and flow cytometry (FC) in counting NRBCs in comparison with manual microscopic counting (MC). Background NRBCs recognition by manual and automatic technologies has been widely evaluated. As transfusion of packed red blood cells is a principal supportive intervention for patients with thalassemia major, monitoring markers of an adequate transfusion therapy is essential in their management. Patients and methods NRBC percentages from 61 thalassemia major patients were analyzed by automated technologies, Sysmex XN-1000 analyzer and FC, and the results were compared with traditional MC as a reference method. Markers of ineffective erythropoiesis were estimated for all patients. Results Pretransfusion hemoglobin levels showed significant negative correlation with NRBC% obtained by Sysmex XN-1000 (r=−0.302, P = 0.018). Furthermore, NRBC% was positively correlated with reticulocyte% (r = 0.852, P Conclusion Monitoring of NRBC% by Sysmex XN-1000 analyzer has many advantages over manual counting and can help to optimize transfusion therapy for patients with beta thalassemia major.

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Predictive value of biochemical and hematological markers in prognosis of asphyxic infants.

Background:Asphyxia is one of the main causes of infant mortality and long-term neurologic complications. This cohort study was aimed to compare the diagnostic value of the hematologic and biochemical factors in the prediction of prognosis of asphyxia according to the high prevalence of asphyxia and its complications.Methods:In this cohort with a two-year follow-up study with availability sampling, 196 term asphyxic infants were involved from 2009 to 2018. A researcher-designed questionnaire was used as the data collection tool containing infantile and maternal particulars as well as the clinical and laboratory assessments. Serum levels of interleukin-1β(IL-1β), IL-6, pro-oxidant/antioxidant balance (PAB), heat shock protein (HSP) and nucleated red blood cells (NRBC) were checked in infants with perinatal asphyxia. Denver II developmental screening test (DDST-II) was performed at 6, 12, 18, and 24 month post-discharge follow-up visits. Data analysis for comparison of infants with normal and abnormal outcomes was performed using student t- test, chi-square, ROC curve, and regression models.Results:IL-6, IL-1β, PAB, and NRBC count are among the most important predictors of abnormal complications in asphyxic newborns. PAB>22 (HK) showed sensitivity and specificity of 88.6% and 71.6%, respectively in the prediction of complications of asphyxia. The sensitivity and specificity of an IL-6 higher than 28 (pg/mL) in the prediction of complications of asphyxia were found to be 96.1% and 78.6%, respectively. Elevated levels of IL-6 and IL-1β were associated with increased unfavorable outcomes.Conclusion:Combinations of: IL-1β+ IL-6 + NRBC; IL-6 + HIE grade + PAB; and IL-6+ HIE grade + NRBC had the highest predictive value (100%) for prognosis of asphyxic infants.

Assessment of Umbilical Cord Nucleated Red Blood Cell Count in Discharged and Dead Very Low Birth Weight Infants

Background: Predictive value of the umbilical nucleated red blood cells (NRBCs) at birth for neonatal outcomes has been assessed. Hence, the present study was conducted to compare NRBC between discharged and dead neonates.Methods: This cross-sectional study was performed on preterm newborns with a birth weight of < 1,500 g admitted to the Neonatal Intensive Care Unit of Ghaem Hospital, Mashhad, Iran, within 2012-2018. The subjects were divided into two groups of discharged and dead. Data collection tool was a researcher-made questionnaire containing three sections, namely maternal demographic information, neonatal data, and blood tests (measuring white blood cell [WBC], absolute NRBC, NRBC/100 WBC and blood gas). The collected data were analyzed in SPSS software (version 20), using t-test, Chi-square test, receiver operating characteristic curve, and regression models.Results: A total of 205 neonates, including 136 discharged neonates (66.03%) and 69 dead neonates (33.7%), were examined in the present study. The results demonstrated a significant difference between the two groups in terms of the first minute Apgar score (P=0.023), fifth minute Apgar score (P=0.010), gestational age (P=0.000), birth weight (P=0.000), WBC (P=0.020), absolute NRBC (P=0.004), NRBC percentage (P=0.001), duration of mechanical ventilation (P=0.029), duration of oxygen therapy (P=0.012).Moreover, mechanical ventilation (P=0.036), type of oxygen therapy (P=0.000), NRBC percentage (P=0.001), and absolute NRBC count (P=0.001) showed a statistically significant relationship with neonatal survival rate.Conclusion: As the findings indicated, mechanical ventilation, type of oxygen therapy, absolute NRBC count, and NRBC percentage can be used as markers for predicting neonatal mortality rate.

Study of diagnostic efficacy of Nucleated Red blood cell count in the early diagnosis of neonatal sepsis

Study of diagnostic efficacy of Nucleated Red blood cell count in the early diagnosis of neonatal sepsis

Comparison of hematological parameters among newborns with meconium stained amniotic fluid and clear amniotic fluid

Background: Meconium stained amniotic fluid is an indirect marker of fetal hypoxia. Fetal hypoxia affects bone marrow and affects production of cell lines. Indirect marker of erythropoietin activity is nucleated red blood cells count. Aim of the study is to compare hematological parameter in newborn born with meconium stained liquor and clear amniotic fluid. Also, to determine cut off levels of nucleated RBC as marker of fetal hypoxia in meconium stained amniotic fluid(MSAF).Methods: The study was conducted over a period of 2 years from January 2012 to January 2014 in Department of Pediatrics, Sri Aurobindo medical college and hospital, Indore. One hundred newborns with meconium stained amniotic fluid (study group) and one hundred newborns with clear amniotic fluids (control group) were studied in this period. Cord blood samples were collected and hematological parameters were compared.Results: Hemoglobin % and WBC counts were seen in study group in comparison to control group, which is statistically significant (P&lt;0.05). The reported NRBC/100 WBC between the two groups was statistically analyzed. The mean NRBC count in study group were 8.09±6.09 which was statistically higher than the corresponding values in control group 2.07±2.25 (P&lt;0.05).Conclusions: Study concluded that the hemoglobin levels , WBC and NRBC counts in babies with meconium stained amniotic fluid is higher than those babies delivered with clear amniotic fluid and NRBC can be taken as a surrogate marker of hypoxia in a resource limited setting.

More Maternal Vascular Malperfusion and Chorioamnionitis in Placentas After Expectant Management vs. Immediate Delivery in Fetal Growth Restriction at (Near) Term: A Further Analysis of the DIGITAT Trial.

Objective: Management of late fetal growth restriction (FGR) is limited to adequate fetal monitoring and optimal timing of delivery. The Disproportionate Intrauterine Growth Intervention Trial At Term (DIGITAT) trial compared induction of labor with expectant management in pregnancies at (near) term complicated by suspected FGR. Findings of the DIGITAT trial were that expectant monitoring prolonged pregnancy for 10 days and increased birth weight with only 130 grams. This resulted in more infants born below the 2.3rd percentile compared to induction of labor, respectively, 12.5% in induction of labor and 30.6% in expectant monitoring group. The main placental lesions associated with FGR are maternal vascular malperfusion, fetal vascular malperfusion, and villitis of unknown etiology. We investigated whether placentas of pregnancies complicated with FGR in the expectant monitoring group reveal more and more severe pathology due to pregnancy prolongation.Material and methods: The DIGITAT trial was a multicenter, randomized controlled trial with suspected FGR beyond 36 + 0 weeks. We now analyzed all available cases (n = 191) for placental pathology. The macroscopic details were collected and histological slides were recorded and classified by a single perinatal pathologist, blinded for pregnancy details and outcome. The different placental lesions were scored based on the latest international criteria for placental lesions as defined in the Amsterdam Placental Workshop Group Consensus Statement.Results: The presence of maternal vascular malperfusion and chorioamnionitis were higher in the expectant management group (p < 0.05 and p < 0.01, respectively). No differences in placental weight and maturation of the placenta between the induction of labor and the expectant management group were seen. Fetal vascular malperfusion, villitis of unknown etiology and nucleated red blood cell count did not differ between the groups.Conclusion: Expectant management of late FGR is associated with increased maternal vascular malperfusion and chorioamnionitis. This may have implications for fetal and neonatal outcome, such as programming in the developing child influencing health outcomes later in life.

Three neglected numbers in the CBC: The RDW, MPV, and NRBC count.

The complete blood cell count (CBC) is one of the most frequently ordered laboratory tests, but some values included in the test may be overlooked. This brief review discusses 3 potentially underutilized components of the CBC: the red blood cell distribution width (RDW), the mean platelet volume (MPV), and the nucleated red blood cell (NRBC) count. These results have unique diagnostic applications and prognostic implications that can be incorporated into clinical practice. By understanding all components of the CBC, providers can learn more about the patient's condition.

Evaluation of Endocrine Complications in Beta-Thalassemia Intermedia Patients: A Cross Sectional Multi-Center Study

The diagnosis of beta thalassemia intermedia (BTI) is mainly based on the severity of clinical phenotype. It is associated with a wide range of specific complications including extramedullary hematopoiesis, leg ulcers, gallstones, hypercoagulable state, pulmonary hypertension (PHT), endocrine disorders and osteoporosis. The commonest endocrine complication in beta thalassemia major (TM) patients is hypogonadism followed by hypothyroidism and diabetes but the data on endocrine disorders in BTI patients are scarce. The aim of this study is to determine the prevalence of endocrine complications in a large series of BTI patients.Methods: In this multi-countries cross-sectional study, all BTI patients registered at 12 thalassemic treatment centers in Iran (2 Centers), Italy (2 Centers), Greece, Turkey (2 centers), Oman, Qatar, Jordan, Cyprus and United Kingdom were enrolled during 2017. Non transfusion- dependent beta-thalassemia patients or those who received blood transfusion 3-4 times or less annually, were evaluated. Required information was collected from medical records using a designed questionnaire. Demographic data, clinical characteristics and laboratory data included age, sex, splenectomy, type of treatment (blood transfusion, iron chelation, hydroxyurea), hormonal assays, bone mineral density, calcium -phosphorous metabolism, serum ferritin, liver function tests, fetal and total hemoglobin levels, platelet and nucleated red blood cell counts, were collected.Results: A total of 721 BTI patients were enrolled in the survey from 9 countries. The most prevalent disease-related complications were osteoporosis (21.6%) and hypogonadism (12.6%) followed by: central hypothyroidism (8.3%), non-insulin-dependent diabetes mellitus (7.8%), primary hypothyroidism (5.5%), insulin-dependent diabetes mellitus (4.2%), hypoparathyroidism (2.2%), growth hormone deficiency (1.1%), adrenal mass (1%) and thyroid cancer (0.5%).Conclusion: This study evaluated the largest cohort of BTI patients with endocrine disorders. Although BTI patients are non-transfusion dependent or only occasionally transfused, iron-overload due to increased intestinal iron absorption and enhanced bone marrow activity cause endocrine disorders and osteoporosis. This study demonstrate that although endocrine complications are less common in patients with BTI compared to data reported in literature in TM patients , a regular monitoring with timely diagnosis and proper management underscoring on osteoporosis and gonadal disorders are crucial to prevent endocrine complications in these patients. DisclosuresNo relevant conflicts of interest to declare.

Cord blood nucleated red blood cell count as a predictor of long term sequelae in cases of perinatal asphyxia: a one-year follow-up study

Background: Nucleated red blood cells (NRBCs) can be easily found in cord blood and its &gt;20/100 WBCs has been distinguished as a marker of perinatal asphyxia at birth. Authors conducted this study to find out if there exists a relation between NRBCs at birth and its effects on long term neurological outcome in patients of perinatal asphyxia.Methods: This was a prospective longitudinal study conducted in the Department of Pediatrics in collaboration with Department of Obstetrics and Gynaecology, G.S.V.M. Medical College, Kanpur from December 2014 to September 2016.Results: On assessing the long term neurodevelopmental outcome in newborns with HIE at birth, Authors found that cord blood NRBCs had no direct influence on the final neurodevelopmental outcome at 1 year of life as did HIE staging.Conclusions: Authors propose that cord blood NRBC counts of &gt; 20/100 WBCs is a good predictor of asphyxia at birth but is definitely not an indicator of forth coming developmental delay.

Nucleated red blood cells and serum lactate values on days2 and5 are associated with mortality and morbidity in VLBW infants.

To correlate nucleated red blood cell counts and serum lactate concentrations on day2 and5 of life with morbidity and mortality in very low birth weight infants and to determine corresponding cutoff values. Retrospective analysis in acohort of very low birth weight infants. 250 very low birth weight infants were included in this study. Gestational age ranged from 23 to 35weeks (mean 29.04) and birth weight was 320-1500 g (mean 1047.9). 55 (22%) patients developed intraventricular hemorrhage, 55 (22%) bronchopulmonary dysplasia, 12 (4.8%) periventricular leukomalacia, 93 (37.2%) retinopathy of prematurity, and 1 (0.4%) necrotizing enterocolitis. Mortality rate was 25/250 (10%). Nucleated red blood cells and serum lactate on day2 of life were associated with mortality (p < 0.001). Serum lactate on day5 of life demonstrated an association with retinopathy of prematurity (p = 0.017), bronchopulmonary dysplasia (p = 0.044), and intraventricular hemorrhage (p < 0.001). Cutoff values predicting mortality were >89.5 nucleated red blood cells/100 leucocytes (sensitivity 68.2%, specificity 89.0%) and serum lactate concentrations >8.5 mmol/l (sensitivity 69.6%, specificity 93.5%) on day2 of life. We conclude that both nucleated red blood cell count and serum lactate concentration are valuable biomarkers in predicting important outcome parameters in very low birth weight infants.