Assessment of clinical impact and predisposing factors for neonatal thrombocytopenia

Abstract

Thrombocytopenia is a common hemostatic abnormality in the newborn infant. The early diagnosis of thrombocytopenia and the underlying primary pathology process play an important role in reducing the risk of severe complications and mortality. We performed a 2-year prospective study of 643 neonates admitted to our neonatology unit to determine the frequency, predisposing factors, and clinical impact of thrombocytopenia. Thrombocytopenia developed in 18.2% of the preterm neonates and 0.8% of the term neonates. Prematurity, sepsis, hypoxia, intrauterine growth retardation, and disseminated intravascular coagulation were identified as predisposing factors for thrombocytopenia. The incidence of complications and mortality were higher in thrombocytopenic infants. Especially the prognosis was worse in cases who had mucosal hemorrhage, without a relation with the degree of thrombocytopenia. The thrombocytopenia occurred by day 2 in 43% of the infants, and resolved by day 8 in 61%. The platelet count nadir occurred by day 2. Since thrombocytopenic infants are at greater risk for bleeding, and the thrombocytopenia itself may have contributed to the high mortality, predisposing factors such as prematurity, infections, hypoxia must be eliminated by providing better care, giving adequate hygiene of both mother and the baby during the prenatal, natal, and neonatal period.

Patterns of Thrombocytosis and Thrombocytopenia in Hospitalized Neonates

“…In agreement with prior findings, [8][9][10] presumed, fungal, Gramnegative, and Gram-positive infections all significantly reduced neonatal PLT counts (Table 2b). In our population, both Gram-positive and Gram-negative infections were associated with lowered PLT counts and a roughly 50% risk of concurrent thrombocytopenia.…”

“…Documented infections were culture proven (positive blood or spinal fluid culture), and effects were examined by ANOVA using CBCs in which a PLT count was made within 1 week (À2 or þ 5 days) of diagnosis. 10 Infants were considered noninfected outside this interval. Infants with NEC were evaluated separately.…”

“…cimetidine). [8][9][10] Severe thrombocytopenia may be associated with increased risk of hemorrhage, and increased mortality. [11][12][13] Thrombocytosis, defined here as a PLT count of >500,000/ml, has been estimated to occur in 1 to 13% of children, usually in the first year of life.…”

The strength of correlation between umbilical cord pH and early neonatal outcome

“…12,14 Our results also showed significant increase in risk of intubation and need for mechanical ventilation among cases with decrease in umbilical arterial pH (p=0.001) as suggested by Goldaber et al, and Andres et al 3,14 Decrease in umbilical arterial pH was significantly associated with low Apgar score in our study (p=0.002) which was consistent with result of other studies done by Goldaber et al and Vandenberg et al 14,15 The incidence of thrombocytopenia found in case group was 58%. The reported incidence in our study was similar to study done by Oren et al, Gunn et al, Gluck man et al [16][17][18] In our study, out of 11 babies with significant acidosis 1 baby (9%) died. Other studies show varying results.…”

Study of risk factors of neonatal thrombocytopenia

“…In a study conducted by Oren et al, an association has been documented between PROM and thrombocytopenia which was similar to results in our study. 17 PROM in mother is a cause of early onset neonatal sepsis eventually leading to neonatal thrombocytopenia.…”