Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Ira
Reproductive Health Research Center, Department of Obstetrics & Gynecology, Alzahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran/
PhD Student in epidemiology, Department of Epidemiology and Biostatistics, School of Public Health,Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Objectives: We aimed to compare the correlation between nucleated red blood cell (NRBC) and creatine kinase (CK) levels with hypoxic-ischemic encephalopathy (HIE) in asphyxiated newborns.
Materials and Methods: This case-control study included 30 asphyxiated (case) and 30 healthy neonates (control) born at Al-Zahra Hospital in Rasht, Iran. We collected the cord blood samples for CK level and NRBC at birth. The clinical stage of Sarnat indicated the severity of HIE. Data were analyzed in the two groups using IBM SPSS Statistics for Windows, version 22.
Results: The case group had a higher NRBC count (P=0.001). The CK level was significantly different between the two groups and was higher in the case group than in the control group (P= 0.002). Results demonstrated a significant association between NRBC count and the occurrence of HIE in neonates with asphyxia (P = 0.021). Besides, a positive correlation was found between HIE and CK levels in the case group (r = 0.7, P=0.001).
Conclusion: According to our results, NRBC count and umbilical cord CK level measurement are valuable predictors of asphyxia and HIE in neonates. In addition, measuring these parameters may help clinicians for faster diagnosis and better management.
- 1. Choi SJ, Park SD, Jang IH, Uh Y, Lee A. The prevalence of vaginal microorganisms in pregnant women with preterm labor and preterm birth. Annals of laboratory medicine. 2012;32(3):194-200. 2. Shoja M, Shoja E. Prevalence and affecting factors of asphyxia in alive newborns in Bojnurd. Journal of North Khorasan University of Medical Sciences. 2015;6(4):779-85. 3. Ezenwa B, Ezeaka C, Fajolu I, Ogbenna A, Olowoyeye O, Nwaiwu O, et al. Impact of Erythropoietin in the management of Hypoxic Ischaemic Encephalopathy in resource-constrained settings: protocol for a randomized control trial. BMC neurology. 2020 May 4;20(1):171. PubMed PMID: 32366288. Pubmed Central PMCID: PMC7199320. Epub 2020/05/06. eng. 4. 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;2(4):179. 5. Guevvera Y. World Health Organisation: Neonatal and perinatal mortality: country, regional and global estimates. WHO cebu: sun. 2006. 6. Lee AC, Kozuki N, Blencowe H, Vos T, Bahalim A, Darmstadt GL, et al. Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. Pediatric research. 2013;74(1):50-72. 7. Uleanya ND, Aniwada EC, Ekwochi U. Short term outcome and predictors of survival among birth asphyxiated babies at a tertiary academic hospital in Enugu, South East, Nigeria. African health sciences. 2019;19(1):1554-62. 8. Rennie JM, Hagmann CF, Robertson NJ. Outcome after intrapartum hypoxic ischaemia at term. Seminars in fetal & neonatal medicine. 2007 Oct;12(5):398-407. PubMed PMID: 17825633. Epub 2007/09/11. eng. 9. Dixon G, Badawi N, Kurinczuk JJ, Keogh JM, Silburn SR, Zubrick SR, et al. Early developmental outcomes after newborn encephalopathy. Pediatrics. 2002 Jan;109(1):26-33. PubMed PMID: 11773538. Epub 2002/01/05. eng. 10. Bala D, Das S. A study of nucleated red blood cell count as a marker of severity of hypoxic ischemic encephalopathy. Int J Contemp Pediatr. 2015;2(3):224-6. 11. Rai R, Tripathi G, Singh DK. Nucleated RBC count as predictor of neurological outcome in perinatal asphyxia. Indian pediatrics. 2014 Mar;51(3):231-2. PubMed PMID: 24736919. Epub 2014/04/17. eng. 12. 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. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2017 Nov;30(21):2551-6. PubMed PMID: 27809621. Epub 2016/11/05. eng. 13. Li J, Kobata K, Kamei Y, Okazaki Y, Nishihara M, Wada H, et al. Nucleated red blood cell counts: An early predictor of brain injury and 2-year outcome in neonates with hypoxic–ischemic encephalopathy in the era of cooling-based treatment. Brain and Development. 2014;36(6):472-8. 14. Meena P, Gunawat M, Suman RL. Correlation of nucleated red blood cells with severity of birth asphyxia and its immediate outcome in term newborns. International Journal of Contemporary Pediatrics. 2016;3(3):841. 15. Walsh B, Boylan G, Murray D. Nucleated red blood cells and early EEG: predicting Sarnat stage and two year outcome. Early human development. 2011;87(5):335-9. 16. Shivaprakash N, Nigam G. Prediction of HIE by nucleated RBC's in cord blood, serum creatine kinase and assessment of outcome by follow up upto 6 months. Journal of Evolution of Medical and Dental Sciences. 2013;2(19):3340-9. 17. Frank C, Nikkels P, Harteman J, Van Haastert I, Benders M, Koopman-Esseboom C, et al. Placental pathology and outcome after perinatal asphyxia and therapeutic hypothermia. Journal of Perinatology. 2016;36(11):977-84. 18. Antonucci R, Porcella A, Pilloni MD. Perinatal asphyxia in the term newborn. Journal of Pediatric and Neonatal Individualized Medicine (JPNIM). 2014;3(2):e030269-e. 19. Bagavathi Priyadarshini C. A Study of Nucleated RBC in Cord Blood as a Prognostic Marker of Perinatal Asphyxia: Tirunelveli Medical College, Tirunelveli; 2017. 20. Alawani SS, Prakash R, Kumar G, 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;7(4):250. 21. Torkestani F, Zafarghndi N, Hadavand S, Zaery F. Umbilical nucleated red blood cell as a sign of fetal distress. Tehran University Medical Journal TUMS Publications. 2008;66(1):29-33. 22. Hermansen M. Nucleated red blood cells in the fetus and newborn. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2001;84(3):F211-F5. 23. Vatansever Ü, Acuna B, Demİr M, KarasalİhoĞlu S, Ekuklu G, Ener S, et al. Nucleated red blood cell counts and erythropoietin levels in high‐risk neonates. Pediatrics international. 2002;44(6):590-5. 24. Ferns SJ, Bhat BV, Basu D. Value of nucleated red blood cells in predicting severity and outcome of perinatal asphyxia. Indian Journal of Pathology & Microbiology. 2004;47(4):503-5. 25. Ghosh B, Mittal S, Kumar S, Dadhwal V. Prediction of perinatal asphyxia with nucleated red blood cells in cord blood of newborns. International Journal of Gynecology & Obstetrics. 2003;81(3):267-71. 26. Geetika, Sikarwar S, Gupta S, editors. The Correlation Of Clinical Perinatal Asphyxia With Counts Of Nrbc/100 Wbc In Cord Blood2011. 27. Korst LM, Phelan JP, Ahn MO, Martin GI. Nucleated red blood cells: an update on the marker for fetal asphyxia. American journal of obstetrics and gynecology. 1996;175(4):843-6. 28. Spencer MK, Khong TY, Matthews BL, MacLennan AH. Haematopoietic indicators of fetal metabolic acidosis. The Australian & New Zealand journal of obstetrics & gynaecology. 2000;40(3):286-9. 29. Colaco SM, Ahmed M, Kshirsagar VY, Bajpai R. Study of nucleated red blood cell counts in asphyxiated newborns and the fetal outcome. International Journal of Clinical Pediatrics. 2014;3(3):79-85. 30. Vandana V, Amit V, Meena V, Anuradha B, Vivek B, Deepak V, et al. Study of basic biochemical and haematological parameters in perinatal asphyxia and its correlation with hypoxic ischemic encephalopathy staging. J Adv Res Biol Sci. 2011;3(2):79-85. 31. Rai R, Tripathi G, Singh D. Nucleated RBC count as predictor of neurological outcome in perinatal asphyxia. Indian pediatrics. 2014;51(3):231-2. 32. Minior VK, Shatzkin E, Divon MY. Nucleated red blood cell count in the differentiation of fetuses with pathologic growth restriction from healthy small-for-gestational-age fetuses. American journal of obstetrics and gynecology. 2000;182(5):1107-9. 33. 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. SSU_Journals. 2010;17(5):330-6. 34. Boskabadi H, Maamouri G, Zakerihamidi M, Bagheri F, Mashkani B, Mafinejad S, et al. Interleukin-6 as A Prognostic Biomarker in Perinatal Asphyxia. Iranian journal of child neurology. 2021 Summer;15(3):119-30. PubMed PMID: 34282369. Pubmed Central PMCID: PMC8272543. Epub 2021/07/21. eng. 35. Masaraddi Sanjay K, Ahamed Roshan P, Nedunchezhian P, Sulekha C. Correlation of serum creatinine kinase muscle-brain fraction and lactate dehydrogenase with severity of hypoxic ischemic encephalopathy in perinatal asphyxia in term neonates. International Journal of Contemporary Pediatrics. 2018;5(2):405. 36. Meena P, Gunawat M, Suman RL. Correlation of nucleated red blood cells with severity of birth asphyxia and its immediate outcome in term newborns. 2016. 2016 2016-12-21;3(3):6. Epub 2016-12-21. 37. Mansour Ghanaie M, Mansour Ghanaie R, Asgari Galebin S M, Sharami S H, Mohebalizade M. Does Labor Affect Neonatal NRBC Count? Journal of Obstetrics, Gynecology and Cancer Research (JOGCR). 2022;7(1):25-31.