NUCLEATED RED-BLOOD-CELLS - A MARKER FOR FETAL ASPHYXIA

OBJECTIVE: Our purpose was to determine whether a relationship exists between the presence of nucleated red blood cells, hypoxic ischemic en cephalopathy, and long-term neonatal neurologic impairment. STUDY DESI GN: Nucleated red blood cell data from 46 singleton term neurologicall y impaired neonates were compared with cord blood nucleated red blood cells of 83 term nonasphyxiated newborns The neurologically impaired n eonates group was also separated as follows: nonreactive, nonreactive fetal heart rate from admission to delivery; tachycardia, reactive fet al heart rate on admission followed by tachycardia with decelerations; rupture, uterine rupture. The first and highest nucleated red blood c ells value and the time to nucleated red blood cells disappearance wer e assessed. RESULTS: The neurologically impaired neonates group exhibi ted a significantly higher number of nucleated red blood cells per 100 white blood cells (34.5 +/- 68) than did the control group (3.4 +/- 3 .0) (p < 0.00001). When the neurologically impaired neonates are separ ated as to the basis for the neurologic impairment, distinct nucleated red blood cell patterns were observed. Overall, the nonreactive group exhibited the highest mean nucleated red blood cell (51.4 +/- 87.5) c ount and the longest clearance times (236 +/- 168 hours). CONCLUSION: in this limited population, nucleated red blood cell data appear to ai d in identifying the presence of fetal asphyxia. When asphyxia was pre sent, distinct nucleated red blood cells patterns were identified that were in keeping with the observed basis for the fetal injury. In gene ral, the closer the birth was to the asphyxial event, the lower was th e number of nucleated red blood cells. Thus our data suggest that cord blood nucleated red blood cells could assist in the timing of fetal n eurologic injury.