Correlation of nucleated red blood cells with severity of birth asphyxia and its immediate outcome in term newborns


  • Pradeep Meena Department of Pediatrics, RNT Medical College, Udaipur (Rajasthan)
  • Maheshwar Gunawat Department of Pediatrics, RNT Medical College, Udaipur (Rajasthan)
  • Rameshwar L. Suman Department of Pediatrics, RNT Medical College, Udaipur (Rajasthan)



APGAR score, Birth asphyxia, Cord blood pH, Nucleated red blood cells, Umbilical cord blood


Background:The severity of birth asphyxia can be predicted by APGAR score and umbilical cord blood pH. The Nucleated Red Blood Cells (NRBCs) in the cord blood at birth emerged as a newer predictor of birth asphyxia. This study was conducted to find the correlation of cord blood Nucleated Red Blood Cell (NRBC) count with the severity of birth asphyxia and its immediate outcome in term newborns.

Methods: An observational hospital based prospective case control study was conducted at inborn NICU, Bal Chikitsalya, RNT Medical College, Udaipur (Raj.) INDIA from March 2015 to September 2015. Total 100 term newborns including 50 as cases (with birth asphyxia) and 50 as controls (normal babies) were enrolled for the study. The cord blood was collected immediately after birth for the measurement of NRBC/100 WBC count and pH value. All the enrolled cases were admitted in NICU and observed for the immediate neurological outcome. The correlation of cord blood NRBC count with APGAR scores, cord blood pH and outcome was analysed statistically.

Results:The mean NRBC (NRBC/100 WBC) count was 17.82±19.55 (range from 0-102) in case group and 1.42±3.26 (range from 0 to 18) in control group (p < 0.001). A statistically significant negative correlation of NRBC count was found with severity of birth asphyxia.

Conclusions:A simple, cheap, rapid and non-invasive test of NRBC count from umbilical cord blood correlates well with APGAR score and cord blood pH to predict the severity of birth asphyxia and immediate outcome.  


Steer PJ, Danielian P. Fetal distress in labour. In: James, Steer, Weiner, Gonik. High Risk Pregnancy. 3rd edition. WB Saunders; 2005:1450-1471.

National Neonatal and Perinatal Database Report. 2002-2003:1-58. Available at Accessed on 02 April 2016.

World Health Organization. Neonatal and perinatal mortality; country, regional and global estimates, 2004; WHO, Geneva. 2006;1-25.

American Academy of Paediatrics, American College of Obstetrician and Gynaecologists. In: Guidelines for Perinatal Care. Gilstral LC, Oh W(Eds.) 5th Ed. Elk Grove Village III. American Academy of Pediatrics. 2002:187.

Namasivayam A, Waldemar A C. Hypoxic ischemic encephalopathy. In: Kliegman RM, Stanton BF, St Geme III JW, Schor NF, eds. Nelson Text Book of Pediatrics. 20th ed. Elseviers Saunders Philadelphia; 2015:838-842.

Green DW, Hendon B, Mimouni FB. Nucleated erythrocytes and intraventricular hemorrhage in preterm neonates. Pediatrics. 1995;96(3):475-8.

Forestier F, DaVos F, Catherine N, Renard M, Andreux JP. Developmental hematopoiesis in normal human fetal blood. Blood. 1991;77:2360-3.

Ghosh B, Mittal S, Kumar S, Dadhwal V. Prediction of perinatal asphyxia with nucleated red blood cells in cord blood of newborns. Int J Gynaecol Obstet. 2003;81(3):267-71.

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

Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. 1976;33(10):696-705.

Hermansen MC. Nucleated red blood cells In the fetus and newborn. Arch Dis Child Fetal Neona Ed. 2001;84:211-5.

Phelan JP, Ahn MO, Korst LM, Martin GI. Nucleated red blood cells: a marker for fetal asphyxia? Am J Obstet Gynecol. 1995;173:1380-4.

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

Colaco SM, Ahmed M, Kshirsagar VY, Bajpai R. Study of nucleated red blood cell counts in asphyxiated newborns and the fetal outcome. Int J Clin Pediatr. 2014;3(3):79-85.

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.

Mohanty AK, Das L, Pradhan S, Meher B, Beriha SS. Cord blood nucleated RBC as a predictor of perinatal asphyxia, severity and outcome. Indian J Clin Pract. 2014;24(10): 983-6.

Boskabadi H, Afshari JT, Ghayour-Mobarhan M, Maamouri GH, Shakeri MT, Sahebkar A. Association between serum interleukin-6 levels and severity of perinatal asphyxia. Asian Biomed. 2010;4:79-85.






Original Research Articles