Reference intervals for circulating nucleated red blood cell counts of neonates, improved by the refineR algorithm

Area of Science:

• Neonatal physiology
• Hematology

Background:

• High nucleated red blood cell (NRBC) counts in neonates are a biomarker for fetal hypoxia and poor outcomes.
• Previous NRBC reference intervals may be inaccurate due to unrecognized fetal hypoxia.
• A novel method, refineR, was developed to create more accurate neonatal NRBC reference intervals.

Purpose of the Study:

• To establish new, more accurate physiological reference intervals for neonatal nucleated red blood cell (NRBC) counts.
• To validate the refineR method for generating these reference intervals using real-world data.

Main Methods:

• Utilized the refineR method for reference interval creation.
• Employed multicentered, real-world data from Intermountain Health.
• Generated reference interval charts for NRBC counts at birth and during the initial postnatal days.

Main Results:

• The refineR method successfully created new reference interval charts for neonatal NRBC counts.
• The newly established intervals are narrower than previous versions.
• The new intervals exhibit lower median and upper-limit values compared to prior data.

Conclusions:

• The new NRBC reference intervals provide a more reliable tool for clinicians.
• Clinicians can more confidently differentiate between normal and elevated NRBC counts in neonates.
• Improved assessment of NRBC counts aids in evaluating fetal hypoxia and predicting neonatal outcomes.