Introduction: Neonatal sepsis is a prevalent medical condition among the babies in all the regions of the world. According to WHO report, annually about 2.7 million neonatal deaths occur worldwide, with more than 35% of them being caused by infectious organisms.

Aim: To enumerate the nucleated RBC count in blood samples of neonates with sepsis. The objective was to relate the count of nucleated RBCs as an early response blood element in detecting the inflammation due to sepsis.

Methodology: A Descriptive study of a sample of 155 neonates divided into culture positive, clinical sepsis and no sepsis groups. The Nucleated Red Blood Cells (NRBC) count per 100 White blood cells (WBC) was counted carefully. A repeat peripheral smear was taken 3 days after admission and compared with the previous results.

Results & Discussion: Out of 115 study neonates, only 101 survived and 14 expired with a mortality of 12.17%. Of the expired 14 babies, 10 were blood culture positive. Mean NRBC in the mortality group was17.1 on day 1, while a repeat count on day 3 showed an increase in the number of circulating NRBCs with mean value 23.1. In the group of babies who survived, NRBCs decreased on day 3 and were even undetected in most of them with a mean value of 3.51. Any unexplained normoblastemia is important because it offers invaluable insight into disease processes or progressions that occur in conditions such as systemic infections.

Conclusion: NRBC count is a simple and valuable marker for detecting the earlier diagnosis of neonatal infection.

Keywords:  Nucleated red blood cells, Neonatal sepsis.

1. Umlauf VN, Dreschers S, Orlikowsky TW. Flow cytometry in the detection of neonatal Int J Pediatr. 2013; 2013:763191.
2. Boskabadi H, Maamouri G, Tavakol Afshari J, Mafinejad S, Hosseini G, Mostafavi-Toroghi H, et al. Evaluation of serum interleukins-6, 8 and 10 levels as diagnostic markers of neonatal infection and possibility of mortality. Iran J Basic Med Sci. 2013; 16(12):1232-7.
3. Delanghe JR, Speeckaert MM. Translational research and biomarkers in neonatal sepsis. Clin Chim Acta. 2015; 451(Pt A):46-64.
4. Dulay AT, Buhimschi IA, Zhao G, Luo G, Abdel-Razeq S, Cackovic M, et al. Nucleated red blood cells are a direct response to mediators of inflammation in newborns with early-onset neonatal sepsis. Am J Obstet Gynecol. 2008; 198(4): 426.e1-9.
5. Miller DR, Baehner RL. Blood Diseases of Infancy and Childhood. 7th ed. St Louis, MO: Mosby; 1995:39-40.
6. Green DW, Mimouni F. Nucleated erythrocytes in healthy infants and in infants of diabetic mothers. J Pediatr. 1990;116:129-131.
7. Crosby WH. Hyposplenism: an inquiry into the normal function of the spleen. Annu Rev Med. 1963;14:349-370.
8. Hanlon-Lundberg KM, Kirby RS Nucleated red blood cells as a marker of acidemia in neonates. Am J Obstet Gynecol. 1999;181:196-201.
9. Sills RH, Hadley RAR. The significance of nucleated red blood cells in the peripheral blood of children. Am J Pediatr Hematol Oncol. 1983;5:173-177.
10. Schwartz SO, Stanbury F. Significance of nucleated red blood cells in peripheral blood: analysis of 1496 cases. JAMA. 1954;154:1339-1340.
11. Hermansen MC. Nucleated red blood cells in the fetus and newborn. Arch Dis Childhood Fetal Neonat Edit. 2001; 84(3):F211-5.
12. Singh Laishram R, Devi Khuraijam R. Hematological and biological markers of neonatal sepsis. Iran J Pathol. 2013; 8(3):137-46.
13. Tandon O.P, Tripathi Y. Red blood cell, Hemoglobin and Anemia. Best and Taylor’s Physiological Basis of Medical Practice. Edition.Wolters Kluwer (India) Pvt Ltd : ; 392. 400.
14. Kliegman, Stanton, St Geme, Schor. Infections of neonates Chapter 109  Nelson Textbook of Pediatrics . I st South Asia Edition: Volume I; Elsevier Publishers; 909.
15. Ramesh Agarwal, Ashole Deorari , Vinod K Paul . Neonatal sepsis AIIMS Protocols in Neonatology. I st Edition; CBS publishers and Distributors Pvt Ltd ;163.
16. Robert G, Christensen Robin K, Ohls John P, Geer , Daniel A, Arber, Bertil Anemias Unique to the Fetus and Neonate.  Wintrobe’s Clinical Hematology. 13^th edition. Wolters Kluwer (India) Pvt Ltd ;1027.
17. M Variation in the Red Cell Parameter in the newborn .Textbook of Pediatric Hematology and Hemato – oncology I st Edition JAYPEE Brothers Medical Publications Ltd ; 25.
18. Kenneth Kaushansky . Examination of blood cells .Williams ‘s Hematology . 9 th Edition; 16
19. Anemia associated with marrow infiltration The Erythrocyte ; McGraw Hill Education; 658
20. Minior VK, Bernstein PS, Divon MY. Nucleated red blood cells in growth-restricted fetuses:
21. associations with short-term neonatal outcome. Fetal Diagn Ther. 2000; 15:165–9. [PubMed: 10782002]
22. Minior VK, Shatzkin E, Divon MY. Nucleated red blood cell count in the differentiation of fetuses with pathologic growth restriction from healthy small-for-gestational-age fetuses. Am J Obstet Gynecol. 2000; 182:1107–9. [PubMed: 10819841]
23. Bonnie T Constantino Bessie Cogionis Nucleated RBCs—Significance in the Peripheral Blood Film Laboratory medicine Vol 31, no 4 April 2000;228.

Dr Gowri .V

Senior Assistant Professor of Physiology, Institute of Physiology and Experimental Medicine, Madras Medical College, Chennai-3, India

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