Predictive value of nucleated red blood cells in diagnosis and prognosis of asphyxia in preterm neonates

Introduction: Nucleated red blood cell (NRBC) count can be used as a simple indicator for evaluation of the severity and primary outcomes of perinatal asphyxia. The current study has aimed to define the predictive value of NRBC count in the diagnosis and outcomes of preterm neonates with asphyxia. Materials and Methods: This cohort study was performed on 353 preterm (gestational age <37 weeks) neonates (168 asphyxia [47.6%] and 185 nonasphyxia [52.4%] neonates) from 2017 to 2021. The neonatal data were recorded. Denver II test was performed at 6, 12, 18, and 24-month follow-up visits. The children were then categorized into two groups of favorable and nonfavorable outcomes (death or developmental delay). Results: NRBC count and NRBC/100 white blood count (WBC) in asphyxia preterm neonates (30 ± 69.6 × 102/mm3 and 9.6 ± 11.2) were significantly higher than nonasphyxia preterm neonates (32.3 ± 54.4 × 102/mm3 and 7.6 ± 9) (P < 0.001). Furthermore, NRBC count and NRBC/100 WBC in preterm asphyxia neonates with unfavorable outcomes (29.2 ± 52.4 × 102/mm3 and 32.17 ± 80.8 × 102/mm3) were significantly higher than those with normal outcomes (15 ± 30.4 × 102/mm3 and 10.14 ± 19.17 × 102/mm3) (P < 0.001). NRBC count >370 had sensitivity and specificity of 69.5% and 57.3%, whereas NRBC/100 WBC >8% had sensitivity and specificity of 63.2% and 63.6% in diagnosing asphyxia in preterm neonates. Furthermore, NRBC count >370 had sensitivity and specificity of 72.6% and 53.8%, whereas NRBC/100 WBC >8% had sensitivity and specificity of 70.5% and 65.1% for the prognosis of asphyxia preterm neonates. Conclusions: According to our findings, NRBC/100 WBC >370 and total NRBC >8% are suitable sensitive predictors of the prognosis of preterm neonates with asphyxia. Evaluation of NRBC count and NRBC/100 WBC can help in the diagnosis of asphyxia and prognosing unfavorable outcomes of asphyxia in asphyxia preterm neonates.