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

Document Type: Original Article

Authors

1 Department of Pediatrics, Faculty of Medicine, Mashhad University o Medical Sciences, Mashhad, Iran

2 Department of Midwifery, Faculty of Medical Sciences, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran

Abstract

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.

Keywords


1. Cunha AD, Fernandes DD, Melo PF, Guedes MH. Fatores associados à asfixia perinatal Factors associated with perinatal asphyxia. Rev Bras Ginecol Obstet. 2004; 26(10):799-805.
2. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet. 2005; 365(9462):891-900.
3. Boskabadi H, Omidian M, Mafinejad S. Neonatal Complications Related with Prolonged Rupture of Membranes .Macedonian Journal of Medical Sciences. 2011;4(1):93-8.
4. Boskabad H, Moudi A, Parvini Z, Barati T. Evaluation of the cause and related factors of neonatal mortality in Qaem hospital 2009-2010. Iran J Obstet Gynecol Infertil. 2012; 14(7):21-6.
5. Boskabadi H, Zakerihamidi M, Sadeghian MH, Avan A, Ghayour-Mobarhan M, Ferns GA. Nucleated red blood cells count as a prognostic biomarker in predicting the complications of asphyxia in neonates. J Maternal Fetal Neonatal Med. 2017; 30(21):2551-6.
6. Boskabadi H, Navaee Boroujeni A, Mostafavi-Toroghi H, Hosseini G, Ghayour-Mobarhan M, Hamidi Alamdari D, et al. Prooxidant-antioxidant balance in perinatal asphyxia. Indian J Pediatr. 2014;81(3):248-53.
7. Hermansen MC. Nucleated red bloodcells in the fetus and newborn. Arch Dis Child Fetal Neonatal Ed. 2001; 84(3):F211-5.
8. Ravishankar V, Buhimschi CS, Booth CJ, Bhandari V, Norwitz E, Copel J, et al. Fetal nucleated red blood cells in a rat model of intrauterine growth restriction induced by hypoxia and nitric oxide synthase inhibition. Am J Obstet Gynecol. 2007;
196(5):482.e1-8.
9. Stachon A, Bolulu O, Holland-Letz T, Krieg M. Association between nucleated red blood cells in bloodand the levels of erythropoietin, interleukin 3, interleukin 6, and interleukin 12p70. Shock. 2005; 24(1):34-9.
10. Boskabadi H, Maamouri G, Afshari JT, Mafinejad S, Hosseini G, Mostafavi-Toroghi H, et al. Evaluation of serum interleukins-6, 8 and 10 levels as diagnostic markers of neonatal infection and possibility of mortality. Iran J Basic Med Sci. 2013; 16(12):1232.
11. Boskabadi H, Sadeghian MH. Investigation of changes in nucleated red blood cells in neonatal infection. Iran J Neonatol. 2017; 8(4):26-32.
12. Perrone S, Vezzosi P, Longini M, Marzocchi B, Tanganelli D, Testa M, et al. Nucleated red blood cell count in term and preterm newborns: reference values at birth. Arch Dis Child Fetal Neonatal Ed. 2005; 90(2):F174-5.
13. Bahman Bijari B, Farahmandinia Z, Hazeghi A. Predictive value of nucleated red blood cell counts in cord and peripheral blood of asphyxiated term neonates in the first week of life. J Shahid Sadoughi Univ Med Sci. 2010; 17(5):330-6.
14. Schaer C, Schmugge M, Frey B. Prognostic value of nucleated red blood cells in critically ill children. Swiss Med Wkly. 2014; 144:w13944.
15. Marchant T, Willey B, Katz J, Clarke S, Kariuki S, Ter Kuile F, et al. Neonatal mortality risk associated with preterm birth in East Africa, adjusted by weight for gestational age: individual participant level meta-analysis. PLoS Med. 2012; 9(8):e1001292.
16. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010; 375(9730):1969-87.
17. International development, poverty. World Bank Group. Available at: URL: http://www.worldbank. org; 2015.
18. Simmons LE, Rubens CE, Darmstadt GL, Gravett MG. Preventingpreterm birth and neonatal mortality: exploring the epidemiology, causes, and interventions. Semin Perinatol. 2010; 34(6):408-15.
19. Oliveira TG, Freire PV, Moreira FT, Moraes JD, Arrelaro RC, Rossi S, et al. Apgar score and neonatal mortality in a hospital located in the southern area of São Paulo City, Brazil. Einstein (São Paulo). 2012; 10(1):22-8.
20. Boskabadi H, Ashrafzadeh F, Doosti H, Zakerihamidi M. Assessment of risk factors and prognosis in asphyxiated infants. Iran J Pediatr. 2015; 25(4):1-6.
21. Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med. 2001; 344(7): 467-71.
22. Hagen EW, Sadek-Badawi M, Carlton DP, Palta M. Permissive hypercapnia and risk for braininjury and developmental impairment. Pediatrics. 2008; 122(3):e583-9.
23. Msall ME. Neurodevelopmental surveillance in the first 2 years after extremely preterm birth:evidence, challenges, and guidelines. Early Hum Dev. 2006; 82(3):157-66.

24. Christensen RD, Henry E, Andres RL, Bennett ST. Reference ranges for blood concentrations of nucleated red blood cells in neonates. Neonatology. 2011; 99(4):289-94.
25. Green DW, Hendon B, Mimouni FB. Nucleated erythrocytes and intraventricular hemorrhage in preterm neonates. Pediatrics. 1995; 96(3):475-8.
26. Krajewski P, Welfel E, Kalinka J, Pokrzywnicka M, Kwiatkowska M. Evaluation of the relationship between circulating nucleated red blood cells count and inborn infection in neonates. Ginekologia Polska. 2008; 79(1):17-22.
27. Boskabadi H, Maamouri G, Sadeghian MH, Ghayour-Mobarhan M, Heidarzade M. Early diagnosis of perinatal asphyxia by nucleated red blood cell count: a case-control study. Arch Iran Med. 2010;
13(4):275.
28. Goel M, Dwivedi R, Gohiya P, Hegde D. Nucleated redblood cell in cord blood as a marker of perinatal asphyxia. J Clin Neonatol. 2013; 2(4):179.
29. Widness JA, Clemons GK, Garcia JF, Oh W, Schwartz R. Increased immunoreactive erythropoietin in cord serum after labor. Am J Obstet Gynecol. 1984; 148(2):194-7.
30. Elveđi Gašparović V, Gverić Ahmetašević S, Čolić A. Nucleated red blood cells count as first prognostic marker for adverse neonatal outcome in severe preeclamptic pregnancies. Collegium Antropol. 2012; 36(3):853-7.
31. Bakhshaee M, Boskabadi H, Hassanzadeh M, Nourizadeh N, Ghassemi MM, Khazaeni K, et al. Hearing impairment in the neonate of preeclamptic women. Otolaryngol Head Neck Surg. 2008; 139(6):846-9.