Comparative Evaluation of Manual and Automated Nucleated Red Blood Cell Counts in Neonates: Insights from a Rural North Indian Tertiary Care Centre

Background:Although a small number of nucleated red blood cells (nRBCs) in neonates is physiological, their enumeration is crucial, especially in critical care, as their presence or elevation can indicate perinatal hypoxia, fetal anaemia, or other pathologic states. Clinical laboratories often prefer automated counting due to the subjectivity and time-consuming nature of manual methods.Methods:The primary aim was to study the comparison of nRBC counts using an automated haematologyanalyser versus the manual method. This prospective cross-sectional study was conducted from November 2024 to February 2025 with a sample size of 100 neonates aged 0–28 days. Automated counting utilised the Sysmex XN-1000 while the manual counting involved analysing a leishman-stained peripheral blood smear under a microscope, reporting nRBCs per 100 WBCs. Result:Of the 100 cases, the majority were male (66%), and most were 0-2 days old (83%). Common symptoms included fever (56%) and jaundice (22%). Haematological analysis showed that 90% of cases had normal haemoglobin (Hb 14-24 gm%) and 86% had normal mean corpuscular volume. Based on automated counts, 40% of cases showed nRBCs less than (