Resumo

MFINGWANA, L et al. Nucleated red blood cells in neonates with hypoxic ischaemic encephalopathy treated with hypothermia: A worthwhile prognostic biomarker for clinicians in LMIC?. S. Afr. j. child health [online]. 2023, vol.17, n.3, pp.117-121. ISSN 1999-7671.  http://dx.doi.org/10.7196/sajch.2023.v17i3.1969.

BACKGROUND: Neonatal hypoxic ischaemic encephalopathy (HIE) is a leading cause of term neonatal death worldwide, with a higher incidence in low- to middle-income settings OBJECTIVE: To investigate whether nucleated red blood cell (nRBC) counts could predict severity of HIE and outcomes in term neonates treated with therapeutic hypothermia (TH METHODS: We conducted a retrospective sub-study at Tygerberg Hospital in Cape Town, South Africa. The review included all cooled neonates' clinical records and blood samples from a National Health Laboratory Services database. One experienced neurodevelopmental expert assessed patients over a period of 12 months RESULTS: Twenty-five files out of a total of 100 were excluded owing to missing data. In accordance with the Thompson HIE score, the cohort was classified as mild (56%), moderate (27%), and severe (17%). All included patients (n=75) had full blood counts within 6 hours of delivery. nRBC were detected in 52% of the samples. There was no correlation between nRBC category and HIE severity (p=0.265). Raised nRBCs (>30 cells/100 white blood cells (WBCs)) were more frequent in infants who died than in those who survived (p=0.008). Infants with nRBC counts >30 cells/100 WBCs had an increased likelihood of having cerebral palsy or impaired neurodevelopment (p=0.013 CONCLUSION: The study demonstrated a significant association between an early increase in nRBC counts in HIE infants treated with TH, and both short- and long-term outcomes. A larger multicentre study is required to better understand the relationship between nRBC counts and HIE in the era of cooling in our local setting

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