Comparative study to correlate hematological parameters with the severity of birth asphyxia

Abstract

Introduction: Birth asphyxia can alter biophysical characteristics of erythrocytes, leukocytes and platelets. Nucleated red blood cell (NRBC) in the umbilical venous blood of neonates has been reported as a possible marker of perinatal asphyxia. NRBCs, platelet count, total leukocyte count, hemoglobin, and hematocrit were taken as hematological parameters. The purpose of this study was to evaluate the various hematological changes following birth asphyxia and their correlation with the severity of birth asphyxia and its outcome. Materials and Methods: It was hospital-based comparative observation study conducted in neonatal units of a tertiary hospital in the northern part of India from May 2019 to May 2020. All term appropriate for gestational age newborns with birth asphyxia were taken as cases and healthy newborns as controls. The sample size of 80 participants in each group was calculated. 2 ml cord blood sample was taken for parameters used in the study. P < 0.05 was taken as statistically significant. Results: There was no statistically significant difference in relation to sex distribution, birth weight, parity of mothers, and mode of delivery between cases and controls. NRBC and total leukocyte count were statistically positively correlated with the severity of hypoxic-ischemic encephalopathy (HIE), whereas hemoglobin, hematocrit, and platelet counts were not statistically significant. Area under the Receiver operating characteristic (ROC) curve of NRBC was 0.812, and the NRBC count cutoff of >20 has a sensitivity of 83% and specificity of 72%. Forty-six percent of total cases with NRBC 20 or more died. Conclusions: NRBC has a significant positive correlation with the severity of HIE and a negative with the Apgar score. NRBCs value more than or equal to 20 can be used as a prognostic marker for assessing the severity and outcome of birth asphyxia.