title: 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.
abstract: BACKGROUND
  Raised nucleated red blood cell (NRBC) counts in neonates may indicate in utero hypoxia and brain damage.
  
  
  OBJECTIVE
  The 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.
  
  
  METHODS
  Forty-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.
  
  
  RESULTS
  Eleven 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.
  
  
  CONCLUSIONS
  NRBC counts can predict brain injury and neurological outcomes in cooled and non-cooled asphyxiated neonates.
authors.affiliation: 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.
authors.forename: Jingang
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kobata
authors.affiliation: Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Kamei
authors.affiliation: Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Okazaki
authors.affiliation: Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nishihara
authors.affiliation: Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.affiliation: Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tamai
authors.affiliation: Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan.
authors.forename: Masahisa
authors.initials: M
authors.lastname: Funato
authors.affiliation: The Ritchie Centre, Monash Institute of Medical Research, Clayton, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
authors.forename: Graham
authors.initials: G
authors.lastname: Jenkin
mesh_terms: D001238:Asphyxia Neonatorum / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002675:Child, Preschool; D004900:Erythroblasts / Q000502:physiology*; D004906:Erythrocyte Count; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D007231:Infant, Newborn; D007958:Leukocyte Count; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Birth asphyxia; Early predictor; Hypothermia; Hypoxic–ischemic encephalopathy; Neurological outcome; Nucleated red blood cells