Role of nucleated red blood cell count in cases of birth asphyxia

Objective: In spite of the improvement in the care of neonates in developin g countries, birth asphyxia still remains a common problem. Asphyxia can oc cur antepartum, intrapartum or postpartum. Elevated nucleated red blood cel l counts have been associated with in utero asphyxia in previous studies. A lso nucleated red blood cell counts have been related to the timing of the asphyxia. This study was undertaken to look at the role of nucleated red bl ood cell count in asphyxiated neonates in relation to the outcome. Methods: In a retrospectively designed study all newborns with the diagnosi s of asphyxia who were admitted to the neonatal intensive care unit at Sult an Qaboos University Hospital between November 1, 1995 to October 30, 1997 were reviewed. The medical charts were reviewed with respect to the paramet ers such as Apgar score, birth weight, sex, place of birth, value of nuclea ted red blood cell count at birth, duration of stay in hospital and mortali ty. A total of 27 term asphyxiated neonates were reviewed. Patients were di vided into 2,groups depending upon their values of nucleated red blood cell count at birth. All patients with normal nucleated red blood cell counts ( 0.5-1.0 x 10(9)/L or 3-10 per 100 WBC) were placed in,group I and all with elevated nucleated red blood cell counts (> 1 x10(9)/L or,>10 per 100 WBC) in group II. Results: Out of 27 neonates, 16 completed the study. Out of 16 neonates, 9 were placed in group I and the remaining 7 in group II. No significant diff erence was noted between the 2 groups with respect to the birth weight and severity of asphyxia. The neonates in group II, with elevated nucleated red blood cell counts, were noted to have increased mortality (28.5%) as compa red to group I (11%). The neonates in group IT also had prolonged hospital stay as compared to the neonates in group I, 8.7 +/- 5.8 and 7.2 +/- 4.3 da ys. Conclusion: We concluded from the study that elevated nucleated red blood c ell counts at birth in asphyxiated neonates, in addition to being used as a marker of fetal asphyxia and timing of asphyxia, may also be used as a pro gnostic marker in predicting the mortality and morbidity. However further p rospective studies with larger population will be needed to confirm our fin dings.