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Background <p>A “high” concentration of nucleated red blood cells (NRBC) in the blood of neonates at birth has been used as a biomarker of fetal hypoxia and a risk factor for poor outcome. Previous neonatal reference intervals for NRBC counts were likely contaminated by high counts from neonates born after unrecognized fetal hypoxia. We hypothesized that a new method for creating reference intervals, <i>refineR</i>, would produce more accurate physiological intervals for neonatal NRBC counts.</p> Study design <p>We utilized <i>refineR</i> and real-world multicentered data from Intermountain Health to create new neonatal NRBC count reference intervals.</p> Results <p>Using 4 ½ years of multi-hospital data, <i>refineR</i> created reference interval charts for NRBC counts at birth <i>and</i> over the first days. The new intervals are narrower than the previous version, with lower median and upper-limit values.</p> Conclusion <p>With the new charts, clinicians can more confidently assess whether a neonate’s NRBC count is normal <i>vs</i>. elevated.</p>

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

  • 期刊论文

  • 发表日期：

    2026年2月23日

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  • Robert D. Christensen,
  • Kelly Doyle,
  • Erick Henry,
  • Sterling T. Bennett,
  • Bailey B. Zeiler,
  • Sarah J. Ilstrup,
  • Erica A. Swenson,
  • Timothy M. Bahr,
  • Robin K. Ohls

摘要

Background

A “high” concentration of nucleated red blood cells (NRBC) in the blood of neonates at birth has been used as a biomarker of fetal hypoxia and a risk factor for poor outcome. Previous neonatal reference intervals for NRBC counts were likely contaminated by high counts from neonates born after unrecognized fetal hypoxia. We hypothesized that a new method for creating reference intervals, refineR, would produce more accurate physiological intervals for neonatal NRBC counts.

Study design

We utilized refineR and real-world multicentered data from Intermountain Health to create new neonatal NRBC count reference intervals.

Results

Using 4 ½ years of multi-hospital data, refineR created reference interval charts for NRBC counts at birth and over the first days. The new intervals are narrower than the previous version, with lower median and upper-limit values.

Conclusion

With the new charts, clinicians can more confidently assess whether a neonate’s NRBC count is normal vs. elevated.