The combined detection of umbilical cord nucleated red blood cells and lactate: early prediction of neonatal hypoxic ischemic encephalopathy.
OBJECTIVE
To establish a simple and quick method that could be used to predict the occurrence of hypoxic ischemic encephalopathy (HIE) as early as possible by investigating the variations of nucleated red blood cells per 100 white blood cell (NRBC/100 WBC) counts and lactate levels in cord blood.


METHODS
In 46 cases of acute fetal distress (AFD) and 54 cases of chronic fetal distress (CFD) neonates we measured the percentage (NRBCs/100 WBC) and lactate in the umbilical blood.


RESULTS
Both lactate levels and NRBC/100WBC counts were higher in CFD and AFD groups than in controls (both P<0.01). The numbers of NRBC/100 WBC and the values of lactate in moderate-severe HIE group were higher than in mild-HIE group (P=0.002 and P=0.042, respectively). The combined sensitivity and specificity was 94% and 96% at 15NRBC/100WBC and 4.25 mmol/L level by combined detecting NRBC and lactate to predict HIE. Three infants (including 1 death and 2 survivors) had the highest levels of NRBC/100WBC and lactate in cord blood, and the 2 survivors had the lowest mental development index (MDI) and psychomotor development index (PDI).


CONCLUSIONS
Combined detection with NRBC/100WBC and lactate allows early prediction of development and severity of HIE. The levels of these parameters are related to the neurodevelopment outcome of HIE infants.
Haiju
Zhang
Z
Department of Pediatrics, Qilu Hospital, Shandong University, China.
Suyuan
Hao
H
Xiufang
Fan
F
Lu
Yang
Y
Sun
Ruopeng
R
D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D004900:Erythroblasts; D004906:Erythrocyte Count; D005260:Female; D005316:Fetal Distress / Q000097:blood*; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis*; D007231:Infant, Newborn; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D014470:Umbilical Cord / Q000737:chemistry / Q000166:cytology*
D015415:Biomarkers; D019344:Lactic Acid