The potential role of nucleated red blood cell (NRBC) count as a marker of illness severity in critically ill neonates

Background
The aim of this study was to assess the diagnostic and prognostic utility of nucleated red blood cells (nRBCs) in critically ill neonates, to help early diagnosis, since they have a high risk of death.


Patients and methods
This cohort study involved 102 neonates with critical illness who were admitted to the Neonatal Intensive Care Unit on their first day of life. Data regarding patient demographics, perinatal risk factors, clinical characteristics, morbidities, and outcomes were collected. Laboratory investigations were performed, including a complete blood picture and a peripheral blood film in which nRBCs were counted.


Results
Non-survivors had a considerably greater nRBC count than survivors, P<0.001. Elevated nRBCs were found to be an independent predictor of newborn mortality, P=0.042. Elevated nRBCs were substantially linked to higher mortality and the requirement for mechanical ventilation. The diagnostic performance test demonstrated a sensitivity of 85.7% and 81.2%, and a specificity of 85.2% and 72.9%, with area under the curve value of 0.906 and 0.799, P<0.001 and P <0.001, respectively.


Conclusion
According to our results, the nRBC count can help clinicians make prompt decisions by acting as a useful early prognostic indicator for death and the need for mechanical ventilation in severely ill newborns.