Comparison of cord blood nucleated red blood cells with clinical markers of perinatal asphyxia

Bhavani Sree K. P.; Tamilselvi D.; Dhanya M.

doi:10.18203/2320-1770.ijrcog20243019

Authors

Bhavani Sree K. P. Department of Obstetrics and Gynecology, Panimalar Medical College and hospital, Chennai, Tamil Nadu, India
Tamilselvi D. Department of Obstetrics and Gynecology, Panimalar Medical College and hospital, Chennai, Tamil Nadu, India
Dhanya M. Department of Obstetrics and Gynecology, Panimalar Medical College and hospital, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20243019

Keywords:

Nucleated RBC, Asphyxia, Meconium stained liquor, Apgar score

Abstract

Background: The fetal compensatory response to hypoxia is erythropoiesis resulting in influx of immature red blood cells into fetal circulation, level of which may be correlated with perinatal asphyxia. Nucleated red blood cells (NRBCs) are commonly seen in the circulation of newborns. The number of NRBCs per 100 white blood cells (WBCs) varies and it is usually less than 10. >10 NRBCs are usually seen in cases of prematurity, Rh sensitization, maternal diabetes mellitus and intra uterine growth retardation. Asphyxia is also said to cause an increase in the nucleated RBC’S in the newborns.

Methods: Study included NRBCs/100 white blood cells in umbilical venous sample and it's comparson with clinical markers of perinatal outcome. A prospective study was done between November 2020 to 2022. Subjects included singleton term babies.

Results: The presence of thick Meconium stained amniotic fluid, non-reassuring FHR pattern and low Apgar at 1 minute was associated with higher number of NRBC and was statistically significant.

Conclusions: Nucleated RBCs in cord blood of the newborns are the best correlators of perinatal outcome compared to the clinical markers.

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References

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

Gilstrap LC, Kenneth J, Leveno KG, Burris J, William ML, Little BD. Diagnosis of birth asphyxia on the basis of fetal Ph Apgar score and newborn cerebral dysfunction Am Obstet Gynecol. 1989;161:825-30.

ACOG Committee opinion: Committee on obstetric practice 138. Utility of umbilical cord blood acid-base assessment. Int J Gynecol Obstet. 1994;49:313.

Arias F. Birth asphyxia. Practical guide to high risk pregnancy and delivery. 2nd Edition. 1993;413-27.

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.

Green DW, Mimouni F. Nucleated erythrocytes in the healthy and infants of diabetic mothers. J Pediatric. 1990;116:129-31.

Philips AGS, Tito AM. Increase~ nucleated RBC counts in small for gestation age infants with very low birth weight. Am J Dis Child. 1989;143:164-9.

Snijders RJM, Abbas A, Melby O. Ireland RM, Nicolaides KH. Fetal plasma erythropoietin concentration in severe growth retardation. Am J Obstet Gynecol. 1993;168:615-9.

Starks GC. Correlation of meconium stained amniotic fluid Early intra partum fetal pH and Apgar score as predictors of perinatal outcome. Obstet Gynecol. 1980;56:604-14.

Jayazeri A, Politz L, Tsibris JC, Queen T, Spellacy WN. Fetal erythropoietin levels in pregnancies complicated by meconium passage: does meconium suggest fetal hypoxia? Am J Obstet Gynecol. 2000;183:188-90.

Pellantova S. Validity of CTG monitoring in the diagnosis of acute fetal hypoxia. Scripta medica (BRNO). 2000;73:251-60.

MacLennon A. A template for defining a causal relation between acute intrapartum events and cerebral palsy: International consensus statement. BMJ. 1999;319:1054-9.

D'souza SW, Black P. MacFarlane T. Jenison RF, Richards B. Hematological values in cord blood in relation to fetal hypoxia. Br J Obstet Gynecol. 1981;88:129-32.

Abramovia H, Brandes JM, Fuch SK. Mechanism during delivery – A sign of compensated fetal distress. Am J Obstet Gynaecol. 1974;118:251.

Kirby KN, Petry NM, Bickel WK. Heroin addicts have higher discount rates for delayed rewards than non-drug-using controls. J Exp Psychol Gen. 1999;128(1):78-87.

Cunningham FG, MacDonald PC, Gant MF. Intra pogrom assessment. In: Cunningham FC, MacDonald PC, Gant MF (eds). Williams Obsterics 20th edition. Connecticut Appleton Lange. 1997: 3-47.

Gosh B, Mittal S, Kumar S, Dudhwal V. Prediction of perinatal asphyxia with nucleated red blood cells in cord blood of newborn. Int J Obstet Gyneacol. 2003;81(3):267-71.