BACKGROUND
Thrombocytopenia is common among small for gestational age neonates (SGA; birth weight <10th % reference range) but several aspects of this thrombocytopenia are unclear, including the incidence, typical nadir, duration, association with preeclampsia, mechanism, and risk of death.
METHODS
Using nine years of multihospital records we studied SGA neonates with ≥2 platelet counts <150,000/μL in their first week.
RESULTS
We found first-week thrombocytopenia in 31% (905 of 2891) of SGA neonates vs. 10% of non-SGA matched-controls (p<0.0001). One hundred-two of the 905 had a recognized cause of thrombocytopenia (DIC, early-onset sepsis, ECMO). This group had a 65% mortality rate. The remaining 803 did not have an obvious cause for their thrombocytopenia. We termed these the “thrombocytopenia of SGA”. They had a mortality rate of 2% (p<0.0001) and a mean nadir count on day 4 of 93,000/μL (standard deviation, 51,580/μL, 10th % 50,000/μL, 90th % 175,000/μL). By day 14, platelet counts were ≥150,000/μL in >half of the patients. Severely SGA neonates (<1st %) had lower counts and longer thrombocytopenia duration (p<0.001). High nucleated red cell counts at birth correlated with low platelets (p<0.0001). Platelet transfusions were given to 23% and counts typically >tripled. Thrombocytopenia was associated with SGA status more so than with the diagnosis of maternal preeclampsia.
CONCLUSIONS
SGA neonates with clearly recognized varieties of thrombocytopenia have a high mortality rate. In contrast the “thrombocytopenia of SGA” is a hyporegenerative condition of moderate severity and two weeks duration, associated with evidence of intrauterine hypoxia, and associated with a low mortality rate.