Nucleated red blood cells (NRBCs) are immature red cells that under normal conditions are not present in the peripheral circulation. Several studies have suggested an association between elevated NRBC and poor outcome in critically ill adults and neonates. We sought to determine if elevations in NRBC value following cardiac surgery and following clinical events during the hospital stay can be used as a biomarker to monitor for mortality risk in neonates post-cardiac surgery.

We constructed a retrospective study of 264 neonates who underwent cardiac surgery at Children’s Hospital, New Orleans between 2011 and 2020. Variables included mortality and NRBC value were recorded following cardiac surgery and following peri-operative clinical events. The study was approved by LSU Health IRB. Sensitivity, specificity, receiver operating characteristic (ROC) curves with area under the curve (AUC) and logistic regression analysis were performed.

Thirty-six patients (13.6%) died, of which 32 had an NRBC value ≥10/100 white blood cell (WBC) during hospitalisation. Multi-variable analysis found extracorporeal membrane oxygenation use (OR 10, 95% CI 2.9–33, p=<0.001), NRBC ≥10/100 WBC (OR 16.1, CI 4.1–62.5, p ≤ 0.001) and peak NRBC in the 14-day period post-cardiac surgery (continuous variable, OR 1.05, 95% CI 1.0–1.09, p = 0.03), to be independently associated with mortality. Using a cut-off NRBC value of 10/100 WBC, there was an 88.9% sensitivity and a 90.8% specificity, with ROC curve showing an AUC of 0.9 and 0.914 for peak NRBC value in 14 days post-surgery and entire hospitalisation, respectively.

NRBC ≥10/100 WBC post-cardiac surgery is strongly associated with mortality. Additionally, NRBC trend appears to show promise as an accurate biomarker for mortality.

有核红细胞 (NRBC) 是未成熟的红细胞，在正常情况下不存在于外周循环中。几项研究表明，NRBC 升高与危重成人和新生儿的不良预后之间存在关联。我们试图确定心脏手术后和住院期间临床事件后 NRBC 值的升高是否可以用作监测心脏手术后新生儿死亡风险的生物标志物。

我们对 2011 年至 2020 年间在新奥尔良儿童医院接受心脏手术的 264 名新生儿进行了一项回顾性研究。在心脏手术后和围手术期临床事件后记录了死亡率和 NRBC 值等变量。该研究得到了 LSU Health IRB 的批准。进行敏感性、特异性、受试者工作特征（ROC）曲线和曲线下面积（AUC）和逻辑回归分析。

36 名患者（13.6%）死亡，其中 32 名住院期间 NRBC 值≥10/100 白细胞（WBC）。多变量分析发现使用体外膜肺氧合（OR 10, 95% CI 2.9–33, p=<0.001），NRBC ≥10/100 WBC（OR 16.1, CI 4.1–62.5, p ≤ 0.001）和峰值 NRBC心脏手术后 14 天（连续变量，OR 1.05，95% CI 1.0-1.09，p = 0.03）与死亡率独立相关。使用 10/100 WBC 的 NRBC 截止值，有 88.9% 的敏感性和 90.8% 的特异性，ROC 曲线显示手术后 14 天和整个住院期间的峰值 NRBC 值的 AUC 分别为 0.9 和 0.914 .

NRBC ≥10/100 WBC 心脏手术后与死亡率密切相关。此外，NRBC 趋势似乎有望成为死亡率的准确生物标志物。