Publication:

Hematological parameters as predictors of short-term outcomes in perinatal birth asphyxia in term neonates: a prospective case-control study

Background Perinatal asphyxia is a significant cause of neonatal morbidity and mortality globally. Haematological changes, particularly in nucleated red blood cell (nRBC) counts, may offer early diagnostic and prognostic insights.

Objective To estimate and compare haematological parameters in term neonates with and without birth asphyxia and to evaluate their association with short-term outcomes, including hypoxic ischemic encephalopathy (HIE) and meconium aspiration syndrome (MAS).

Methods A hospital-based prospective observational case-control study was conducted among 170 term neonates, comprising 85 neonates with birth asphyxia and 85 healthy controls. Haematological parameters including haemoglobin, haematocrit, platelet count, total leukocyte count, absolute nRBC count and nRBCs/100 white blood cells (WBCs) were analysed within six hours of birth. Statistical analysis was performed using Student’s t-test, Chi-square test and ANOVA, with p<0.05 considered statistically significant.

Results Cases demonstrated significantly higher absolute nRBC counts (0.784±0.5957 vs. 0.0609±0.0156) and nRBCs/100 WBCs (2.3035±1.4014 vs. 0.6098±0.15633) compared with controls (p<0.001). Elevated nRBC levels showed significant associations with the severity of birth asphyxia, HIE staging, occurrence of MAS and prolonged hospital stay. Total leukocyte count was also significantly increased among cases, whereas haemoglobin, haematocrit and platelet counts did not differ significantly between the groups.

Conclusions Absolute nRBC count and nRBCs/100 WBCs are inexpensive, readily available haematological markers that correlate with the severity and short-term outcome of perinatal asphyxia. Their incorporation into the routine evaluation of asphyxiated neonates may facilitate early risk stratification and prognostication.