Cord blood nucleated red blood cell count as a predictor of long term sequelae in cases of perinatal asphyxia: a one-year follow-up study

Ashok Kumar, Rupa Dalmia Singh, Shashank Suryavanshi, Kriti Mohan


Background: Nucleated red blood cells (NRBCs) can be easily found in cord blood and its >20/100 WBCs has been distinguished as a marker of perinatal asphyxia at birth. Authors conducted this study to find out if there exists a relation between NRBCs at birth and its effects on long term neurological outcome in patients of perinatal asphyxia.

Methods: This was a prospective longitudinal study conducted in the Department of Pediatrics in collaboration with Department of Obstetrics and Gynaecology, G.S.V.M. Medical College, Kanpur from December 2014 to September 2016.

Results: On assessing the long term neurodevelopmental outcome in newborns with HIE at birth, Authors found that cord blood NRBCs had no direct influence on the final neurodevelopmental outcome at 1 year of life as did HIE staging.

Conclusions: Authors propose that cord blood NRBC counts of > 20/100 WBCs is a good predictor of asphyxia at birth but is definitely not an indicator of forth coming developmental delay.


Long term neurodevelopmental outcome, Nucleated RBCs, Perinatal asphyxia

Full Text:



Low JA. The role of blood gas and acid-base assessment in the diagnosis of intrapartum fetal asphyxia. Am J Obstet Gynecol. 1988 Nov 1;159(5):1235-40.

World Health Report. Geneva, Switzerland: WHO. 1997. Available at

NNPD network. National Neonatal Perinatal Database–report for the year 2002-2003. NNF NNPD network. New Delhi: 2005. Available at

Green DW, Mimouni G. Nucleated erythrocytes in healthy infants and in infants of diabetic mothers. J Pediatr. 1990;166:129-31.

Philip AG, Tito AM. Increased nucleated red blood cell counts in small for gestational age infants with very low birth weight. Am J Dis Child. 1989;143:164-9.

Saracoglu F, Sahin I, Eser E, Gol K, Turkkani B. Nucleated red blood. Cells as a marker in acute and chronic fetal asphyxia. Int J Gynaecol Obstet. 2000;71:113-8.

Phelen JP, Kirkendall C, Korst LM, Martin GI. Nucleated red blood cell and platelet counts in asphyxiated neonates sufficient to result in permanent neurologic impairment. J Matern Fetal Neonatal Med. 2007;20:377-80.

Papa D, Jyotsna GP, Ashok BB. Cord blood nucleated red blood cell count - a marker of fetal asphyxia. J Obstet Gynecol India. 2008 Feb; 58(l):45-8.

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 Iranian Med. 2010 Jul 1;13(4):275.

Thilaganathan B, Athanasious S, Ozmen S, Creighton S, Watson NR, Nicolaides KH. Umbilical cord blood erythroblast count as an index of intrauterine hypoxia. Arch Dis Child Fetal Neonatal Ed. 1994;70(3):Fl92-4.

Phelan JP, Ahn MO, Korst LM, Martin GI. Nucleated red blood cells: a marker for fetal asphyxia?. Am J Obstet Gynecol. 1995;173:1380.

Walsh BH, Boylan GB, Murray DM. Nucleated Red Blood Cells and early EEG: Predicting Sarnat stage and two-year outcome. Early Hum Dev. 2011 May;87(5):335-9.

Shivaprakash NC, 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. J Evol Med Dental Sci. 2013 May 13;2(19):3340-9.