Case control study of nucleated RBC’s in cord blood as a predictor of perinatal asphyxia its severity and outcome


  • Mandeep Singh Khurana Department of Pediatrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
  • Sunita Arora Department of Pediatrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
  • Supriya Malik Department of Pediatrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
  • Jasgobind Singh Gulati Department of Pediatrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India



HIE, Neonates, NRBC’s, Perinatal asphyxia, Term


Background: Perinatal asphyxia word derived from the greek word a-spyxos, meaning born without an evident pulse, is one of the most important causes of fetal distress. Inspite of major advances in technology and knowledge of fetal and perinatal medicine, it is one of the significant causes of mortality and long-term morbidity. World health organization (WHO) has defined perinatal asphyxia as a failure to initiate and sustain breathing at birth. HIE is one of the most common complication in an asphyxiated neonate because of its serious longterm neuromotor sequalae among the survivors. A detailed classification of HIE staging in term neonate was proposed by Sarnat and Sarnat.

Methods: The present study was prospective case control study conducted in neonatal intensive care unit of Department of Pediatrics at SGRD institute of medical sciences and research over a period of one year from September 2016 to august 2017. Total of 100 newborns among which 50 asphyxiated babies were designated to case group and rest 50 normal term babies to control group. The NRBC count of the case and control groups is compared. The NRBC’s of subjects belonging to different stages of HIE is then compared. The results were analysed statistically chi-square analysis for variance (qualitative analysis), t-test (compare mean NRBC’s in different stages) by SPSS version 20 software for biostatistic and p-value of <0.05 was considered statistically significant.

Results: Among total 100 babies included in the study, the male and female distribution was 22 (44%) and 28 (56%) in cases and 23 (46%) and 27 (54%) in controls respectively. In our study, the NRBC /100 WBC count for normal newborn was 0.88±1.35 and in case group it was 21.40±20.

Conclusions: In present study, the cord blood NRBC count was shown to be a good predictor of perinatal asphyxia with sensitivity of 86%, specificity of 100%, positive predictive value of 100% and negative predictive value of 87.72%. NRBC’s can be used for early detection of HIE and its grading in asphyxiated neonates. 


Steer PJ, Danielian P. Fetal distress in labour. In: James, Steer, Weiner, Gonik. High risk pregnancy. 3rd edition. WB Saunders. 2005:1450-71.

National Neonatal and Perinatal Database Report. 2002-2003:1-58. Available at

World Health Organization. Neonnatal and Perinatal Mortality; Country, Regional and Global estimates, 2004; WHO, Geneva. 2006:1-25.

Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: A clinical and electroencephalographic study. Arch Neurol. 1976;33:695-706.

Lippman HS. Morphologic and quantitative study of blood corpuscles in the newborn period. Am J Dis Children.1924;27:473-515.

Green DW, Mimouni F. Nucleated erythrocytes in healthy infants and in infants of diabetic mothers. J Pediatr. 1990;116(1):129-131.

Ghosh B, Mittal S, Kumar S, Dadhwal V. Prediction of perinatal asphyxia with nucleated red blood cells in cord blood of newborns. Int J Gynecol Obstet. 2003;81(3):267-271.

Fox H. The incidence and significance of nucleated erythrocytes in the foetal vessels of the mature human placenta. J Obstet Gynecol Br Commonw. 1967;74(1):40-3.

Sikarwar S, Gupta S. The correlation of clinical perinatal asphyxia with counts of NRBC/100 WBC in cord blood. Webmed Central Obstet Gynaecol 2011;2(1):001511

Saraçoglu F, Sahin I, Eser E, Göl K, Türkkani B. Nucleated red blood cells as a marker in acute and chronic fetal asphyxia. Int J Gynecol Obstet. 2000;71(2):113-8.

Hermansen MC. Nucleated red blood cells in the fetus and newborn. Arch Dis Child Fetal Neonatal Ed. 2001;84(3):F211-F215.

Phelan JP, Korst LM, Ahn MO, Martin GI. Neonatal nucleated red blood cell and lymphocyte counts in fetal brain injury. Obstet Gynecol. 1998;91(4):485-9.

Hanlon-Lundberg KM, Kirby RS. Nucleated red blood cells as a marker of acidemia in term neonates. Am J Obstet Gynecol. 1999;181(1):196-201.

Boskabadi H, Maamouri G, Sadeghian MH, Ghayour Mobarhan M, Heidarzade M, Shakeri MT, et al. Early diagnosis of perinatal asphyxia by nucleated red blood cell count: a case-control study. Arch Iran Med/ 2010;13(4):275-81.

Shivaprakash NC, Nigam G. Prediction of HIE by nucleated RBC's in cord blood, serum creatine kinase and assessment of outcome by follow up up to 6 months. J Evol Med Dental Sci. 2013:2(19):3340-8.

Ferns SJ, Bhat BV, Basu D. Value of nucleated red blood cells in predicting severity and outcome of perinatal asphyxia. Indian J Pathol Microbiol. 2004;47(4):503-5.

Mohammed LH, Mohammed NR, AL-Hussieny NA, Rezq SH. Early Predictions of Hypoxic-Ischemic Encephalopathy by Umbilical Cord Nucleated Red Blood Cells and Lactate Med. J Cairo Univ. 2011;79(1):625-631.






Original Research Articles