A study of nucleated red blood cell count as a marker of severity of hypoxic ischemic encephalopathy


  • Dipankar Bala Department of Pediatrics, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
  • Sankar Das North Bengal Medical College & Hospital, Medical Rd, Thiknikata, Darjeeling-734012, West Bengal, India




Hypoxic ischemic encephalopathy (HIE), Nucleated red blood cell (nRBC)


Background: Encephalopathy is a term used to describe central nervous system dysfunction. Neonatal encephalopathy associated with perinatal asphyxia is called hypoxic ischemic encephalopathy. Birth asphyxia and subsequently developing Hypoxic Ischemic Encephalopathy (HIE) is one of the major causes of perinatal mortality and morbidity especially in developing countries like India. The present study will be carried out to analyse nucleated red blood cell count and to find out a relationship between this and severity of HIE.  

Methods: A prospective (case control) study was undertaken between august 2011 and October 2013 in the neonatal intensive care unit, the study population was consisted of 50 full term infants with asphyxia (group-1) and 50 healthy new-born (group-2).  

Results: The average absolute nRBC count (nRBC/mm3) for the control group was 38.6/mm3. It is 426.55/mm3 in the first period with SD of 203.99 & a SEM of 48.08 (in HIE Gr-I). It increases with time in 2nd period and again decreases in the third time period. However the average value is always higher than the control group (p<0.001). In case of HIE Gr-II the average nRBC count is 498.45 with SD of 214.72 and a SEM of 56.8 whereas these are 412.43, SD of 202.54 & SEM of 48.32 in case of HIE Gr-III. So there is a positive correlation between the absolute number of nRBC count and HIE, but there is no linear correlation between the nRBC count and the severity of HIE.

Conclusions: Nucleated red blood cell count (nRBC) count increases in all grades of HIE, but there is no linear correlation between nRBC count and the severity of HIE.  


World Health Organization. The World Health Report, Life in 21st Century F A Vision for All. 2. State of the World’s Newborns. Save the Children. WHO: Geneva; 1998. Washington, DC; 2001.

Bryce J, Boschi-Pinto C, Shibuya K, Black RE. Who estimates of the causes of death in children? Lancet. 2005 Mar-Apr;365(9465):1147-52.

Lawn J, Shibuya K, Stein C. No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bull World Health Organ. 2005 Jun; 83(6):409-17.

Shah P, Riphagen S, Beyene J, Perlman M. Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2004;89:f152-5.

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

Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. New Engl J Med. 2001;344:467-71.

Moster D, Lie RT, Irgens LM, Bjerkedal T, Markestad T. The association of Apgar score with subsequent death and cerebral palsy: a population based study in term infants. J Pediatr. 2001;138:798-803.

Boskabadi H, Maamouri G, Sadeghian MH, GhayourMobarhan 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;13:275.

Vibhuti S, Joseph B, Prakesh S, Max P. Association between haematologic findings and brain injury due to neonatal hypoxic ischaemic encephalopathy. Pediatr Res. 1997;41:181.






Original Research Articles