Nucleated Red Blood Cells as a Prognostic Marker in Neonatal Intensive Care Unit

Background: Nucleated red blood cells (NRBCs) are normally present in the circulation of the fetus during the intrauterine life but they disappear early in the first 10 postnatal days in healthy neonates. We aimed to assess the relations between NRBCs and the prognosis in neonatal intensive care unit (NICU). 
Patients and Methods: This prospective cohort study was carried out on 120 neonates admitted to Tanta University NICU from January 2021 to January 2022. Full maternal history taking, detailed history of resuscitation and complete systemic examination were done. Three samples for complete blood picture analysis & NRBCs count were taken in 1st 24 hours of admission, between 2nd -10th day, and after 10th day of admission. 
Results: 32 cases out of 120 cases had NRBCs beyond normal range (>10/100WBCs) in the 1st 24 hours of admission; 28 of them died (87.5%). 19 cases had NRBCs beyond normal range between the 2nd and 10th day; 17 of them died (89.5%). 31 cases had detectable NRBCs after 10th day; NRBCs 30 of them died (96.8%). There was a statistically significant positive correlation between the presence of NRBCs count above normal range and the number of deceased cases (P = 0.001). 
Conclusions: Nucleated red blood cells monitoring is a promising affordable marker that can predict poor prognosis in NICU.