Cord blood nucleated red blood cell levels as a diagnostic and prognostic tool in birth asphyxia – A cross-sectional study

Background: Perinatal asphyxia remains a major cause of neonatal morbidity and mortality. Traditional diagnostic markers, such as Apgar scores and blood gas analysis, lack sensitivity in predicting long-term neurological outcomes. This study evaluates the utility of cord blood nucleated red blood cell (nRBC) count as a diagnostic and prognostic marker in perinatal asphyxia. Aims and Objectives: The aims and objectives of the study are to assess the predictive value of nRBC/100 white blood cells (WBC) in identifying perinatal asphyxia and correlate its levels with Apgar scores, hypoxic-ischemic encephalopathy (HIE) stages, and short-term mortality. Materials and Methods: A cross-sectional study was conducted on 100 neonates, including 60 with asphyxia (cases) and 40 without (controls), over 12 months. Cord blood was analyzed for hemoglobin, total leukocyte count, and nRBCs. HIE staging and outcomes were recorded. Results: Asphyxiated neonates had significantly higher mean nRBC counts (16.83 vs. 2.48/100 WBCs; P<0.001). A strong negative correlation was observed between nRBC levels and 5-min Apgar scores (r=−0.863) and a strong positive correlation with HIE staging (r=0.94). Neonates who died had markedly elevated nRBC levels (32.75±11.88 vs. 8.14±7.88 in survivors; P<0.0001). Conclusion: nRBC count is a simple, inexpensive, and effective marker for diagnosing perinatal asphyxia and predicting its severity and outcomes. Its use is especially valuable in resource-limited settings.