Document Type : original article
Authors
1 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Department of Pediatrics, Fellowship of Neonatology, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Department of Pediatrics Hematology and Oncology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Abstract
Background: This study aimed to compare the Nucleated red blood cells (NRBC)/100 White blood cells (WBC) ratio in blood samples collected at birth between normal premature newborns and deceased infants.
Methods: This cross-sectional descriptive study was conducted on preterm infants younger than 32 weeks who were admitted to the neonatal ward of Ghaem Hospital in Mashhad, Iran, from 2017 to 2024 using available sampling. Deceased infants were included in the case group, whereas those with normal development until discharge from the hospital were included in the control group. The NRBC results were compared between the two groups. All data were recorded and analyzed using SPSS version 25.
Results: The study included 277 children; 172 (62.1%) had a normal prognosis (control group) and 105 (37.9%) died (case group). The mean absolute NRBC count in deceased infants was 1718.59 ± 3693.77, approximately 13 times higher than that in infants with a normal prognosis. The NRBC/100 WBC ratio was five times higher in deceased infants than in those with normal prognosis. An absolute NRBC count >300/mm² indicated poor prognosis, with 75% sensitivity and 63% specificity. An NRBC/100 WBC ratio >11 predicted infant death with 88.6% sensitivity and 71.2% specificity (P=0.000). An absolute NRBC >190/mm² predicted infant death with 86% sensitivity and 82.2% specificity (P=0.000).
Conclusion: This study highlighted the prognostic value of NRBC counts in newborns and showed that the NRBC/100 WBC ratio was five times higher in deceased infants. Regular NRBC monitoring can guide early intervention and improve neonatal care and survival rates by identifying at-risk infants and tailoring medical treatment to enhance outcomes.
Keywords
- Morniroli D, Tiraferri V, Maiocco G, De Rose DU, Cresi F, Coscia A, et al. Beyond survival: the lasting effects of premature birth. Frontiers in Pediatrics. 2023 Jul 7;11:1213243.
- Nsugbe E, Reyes‐Lagos JJ, Adams D, Samuel OW. On the prediction of premature births in Hispanic labour patients using uterine contractions, heart beat signals and prediction machines. Healthcare Technology Letters. 2023 Feb;10(1-2):11-22.
- Lammertink F, Vinkers CH, Tataranno ML, Benders MJ. Premature birth and developmental programming: mechanisms of resilience and vulnerability. Frontiers in psychiatry. 2021 Jan 8;11:531571.
- de Mendonça EL, de Lima Macêna M, Bueno NB, de Oliveira AC, Mello CS. Premature birth, low birth weight, small for gestational age and chronic non-communicable diseases in adult life: A systematic review with meta-analysis. Early human development. 2020 Oct 1;149:105154.
- Pikora K, Krętowska-Grunwald A, Krawczuk-Rybak M, Sawicka-Żukowska M. Diagnostic value and prognostic significance of nucleated red blood cells (NRBCs) in selected medical conditions. Cells. 2023 Jul 9;12(14):1817.
- Zakerihamidi M, Moradi A, Bagheri F, Boskabadi H. Predictive Value of Nucleated Red Blood Cells in Diagnosis and Prognosis of Asphyxia in Preterm Neonates. Journal of Clinical Neonatology. 2023 Apr 1;12(2):47-52.
- Morton SU, Brettin K, Feldman HA, Leeman KT. Association of nucleated red blood cell count with mortality among neonatal intensive care unit patients. Pediatrics & Neonatology. 2020 Dec 1;61(6):592-7.
- Sokou R, Ioakeimidis G, Lampridou M, Pouliakis A, Tsantes AG, Tsantes AE, et al. Nucleated red blood cells: could they be indicator markers of illness severity for neonatal intensive care unit patients?. Children. 2020 Oct 27;7(11):197.
- Cohen MC, Peres LC, Al-Adnani M, Zapata-Vázquez R. Increased number of fetal nucleated red blood cells in the placentas of term or near-term stillborn and neonates correlates with the presence of diffuse intradural hemorrhage in the perinatal period. Pediatric and Developmental Pathology. 2014 Jan;17(1):1-9.
- Fevereiro-Martins M, Santos AC, Marques-Neves C, Guimarães H, Bicho M. Complete blood count parameters as biomarkers of retinopathy of prematurity: A Portuguese multicenter study. Graefe's Archive for Clinical and Experimental Ophthalmology. 2023 Oct;261(10):2997-3006.
- Boskabadi H, Zakerihamidi M, Moradi A. Predictive value of biochemical and hematological markers in prognosis of asphyxic infants. Caspian Journal of Internal Medicine. 2020;11(4):377.
- Boskabadi H, Sadeghian MH, Meshkani B, Zakerihamidi M. Comparison of the percentage of NRBC/100 WBC in early onset sepsis and non-infectious premature infants. Инфекция и иммунитет. 2021;11(6):1089-94.
- Mansour Ghanaie M, Mansour Ghanaie R, Asgari Galebin SM, Sharami SH, Mohebalizade M. Does labor affect neonatal NRBC count?. Journal of Obstetrics, Gynecology and Cancer Research. 2021 Sep 9;7(1):25-31.
- Pedersen SJ, Chok R, McKillop S, Rojas-Vasquez M, Duff JP, Szkotak A, et al. Peripheral nucleated red blood cells and mortality in critically ill children. Journal of Pediatric Hematology/Oncology. 2022 Apr 1;44(3):79-83.
- Chen D, Zhou K, Tian R, Wang R, Zhou Z. Predictive value of the dynamics of absolute lymphocyte counts for 90-day mortality in ICU sepsis patients: a retrospective big data study. BMJ open. 2024 Jul 1;14(7):e084562.
- Goel M, Dwivedi R, Gohiya P, Hegde D. Nucleated red blood cell in cord blood as a marker of perinatal asphyxia. Journal of Clinical Neonatology. 2013 Oct;2(4):179.
- Gaulee P, Bliznyuk N, Rajderkar D, Graham G, Sura L, Harris J, et al. NRBC concentrations over time in neonates with moderate to severe neonatal encephalopathy with and without sentinel events. Journal of Perinatology. 2024 Aug;44(8):1157-62.
- Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, et al. Education, implementation, and teams: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2020 Oct 20;142(16_suppl_1):S222-83.
- Olasveengen TM, de Caen AR, Mancini ME, Maconochie IK, Aickin R, Atkins DL, et al. 2017 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations summary. Circulation. 2017 Dec 5;136(23):e424-40.
- Boskabadi H, Rakhshanizadeh F, Zakerihamidi M. Assessment of Umbilical Cord Nucleated Red Blood Cell Count in Discharged and Dead Very Low Birth Weight Infants. Iranian Journal of Neonatology. 2020 Jan 1;11(1).
- Cremer M, Roll S, Gräf C, Weimann A, Bührer C, Dame C. Nucleated red blood cells as marker for an increased risk of unfavorable outcome and mortality in very low birth weight infants. Early human development. 2015 Oct 1;91(10):559-63.
- El Mashad GM, El Saied HM, El-Koomy HA, Abo El-Khair NT. Prognostic value of nucleated red blood cells in critically ill neonates. Menoufia Medical Journal. 2023;35(4):1862-6.
- Boskabadi H, Bagheri F, Bayaty MM. The Relationship between Evolutionary Premature Infants at the Age of Two and the Number of Nucleated Red Blood Cell Peripheral Blood. Journal of Babol University of Medical Sciences. 2020 Jan 1;22(1).
- Piggott KD, Norlin C, Laviolette C, Turner J, Lewis L, Soliman A, et al. Nucleated red blood cells as a biomarker for mortality in infants and neonates requiring veno-arterial extracorporeal membrane oxygenation for cardiac disease. Perfusion. 2023 Mar;38(2):299-304.
- Christensen RD. Nucleated Red Blood Cells in Neonatal Medicine. Neonatology Questions and Controversies: Hematology and Transfusion Medicine-E-book. 2023 Aug 1:27.
- Nitzan I, Roberts CT, Bhatia R, Mimouni FB, Sehgal A. Nucleated Red Blood Cells as Markers of Perinatal Adaptation in Preterm Neonates Receiving Minimally Invasive Surfactant Therapy. American journal of perinatology. 2022 Dec;39(16):1792-5.
- Kil TH, Han JY, Kim JB, Ko GO, Lee YH, Kim KY, et al. A study on the measurement of the nucleated red blood cell (nRBC) count based on birth weight and its correlation with perinatal prognosis in infants with very low birth weights. Korean journal of pediatrics. 2011 Feb 28;54(2):69.
- Poryo M, Wissing A, Ayguen A, Geisel J, Wagenpfeil S, Zemlin M, et al. Reference values for nucleated red blood cells and serum lactate in very and extremely low birth weight infants in the first week of life. Early Human Development. 2017 Feb 1;105:49-55.
- Alawani SS, Prakash R, Kumar GM, Rudrappa S, Krishnamurthy B. Predictive ability of venous blood nucleated red blood cells counts in term infants with perinatal asphyxia: A diagnostic study. Journal of Clinical Neonatology. 2018 Oct 1;7(4):250-3.
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