• Brain & development · Jun 2014

    Nucleated red blood cell counts: an early predictor of brain injury and 2-year outcome in neonates with hypoxic-ischemic encephalopathy in the era of cooling-based treatment.

    • Jingang Li, Keisuke Kobata, Yoshiya Kamei, Yoko Okazaki, Masato Nishihara, Hiroshi Wada, Hiroshi Tamai, Masahisa Funato, and Graham Jenkin.
    • Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan; The Ritchie Centre, Monash Institute of Medical Research, Clayton, VIC, Australia. Electronic address: s-ri@hotmail.co.jp.
    • Brain Dev. 2014 Jun 1; 36 (6): 472-8.

    BackgroundRaised nucleated red blood cell (NRBC) counts in neonates may indicate in utero hypoxia and brain damage.ObjectiveThe study aimed to examine the use of NRBC counts as a predictor of brain injury and neurodevelopmental outcomes in neonates with hypoxic-ischemic encephalopathy (HIE) treated under current cooling-based strategy.MethodsForty-three neonates with asphyxia between 2004 and 2010 were retrospectively investigated. Twenty neonates with moderate/severe HIE underwent hypothermia (HT), and 23 with mild HIE were treated in normothermia (NT). Neonates were divided into groups according to the presence of cerebral parenchymal lesions on magnetic resonance imaging (MRI) at 2 weeks after birth. All patients were followed-up neurologically for ⩾ 24 months. NRBC counts during the first 3 days were compared between groups.ResultsEleven HT (HT-N) and 21 NT (NT-N) neonates had normal MRI, and 9 HT (HT-L) and 2 NT (NT-L) neonates had parenchymal lesions. NRBC counts, both absolute and /100 white blood cells (WBC) counts, during the first 3 days in HT-L and NT-L were significantly higher than those in HT-N and NT-N, particularly within 6 hours after birth (HT-N: 502 [0-3060]/mm(3) vs HT-L: 2765 [496-6192]; 0 [0-3417] vs NT-L: 4384 [3978-4789], median [range]). Neonates with /100 white blood cells ⩾ 6/mm(3) and absolute NRBC counts ⩾ 1324/mm(3) within 6 hours of birth had high risks of abnormal MRIs and 2-year outcomes.ConclusionsNRBC counts can predict brain injury and neurological outcomes in cooled and non-cooled asphyxiated neonates.Copyright © 2013 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

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