Neonatal thrombocytopenia—causes and outcomes following platelet transfusions

Abstract

We evaluated the causes for neonatal thrombocytopenia (NT), the duration of NT, and the indications of platelet transfusions (PT) by means of a retrospective cohort study over a 23-year period. Neonates with NT were identified via ICD-10 code D69.6. Of 371 neonates (1.8/1000 live births) with NT, the majority (312; 84.1%) had early onset thrombocytopenia, and 282 (76%) were preterm born. The most frequent causes for NT were early and late onset sepsis and asphyxia. The mean duration of thrombocytopenia was 10.2 days and was negatively correlated (KK = − 0.35) with the number of PT. PT were given to 78 (21%) neonates, 38 (49%) of whom had very severe NT. The duration of NT was positively related to the severity of NT and the number of subsequent PT. A mortality rate of 10.8% was significantly associated with bleeding signs (p < 0.05) and correlated with increasing number of PT (p < 0.05) but not with the severity of NT (p = 0.4). In the case of relevant hemorrhage, PT did not influence the mortality rate (p = 0.09). All deaths followed neonatal sepsis.Conclusions: Prematurity and diagnoses including early and late onset sepsis and asphyxia were the most common causes of NT. Mortality was not associated with the severity of NT but increased with the number of PT. What is Known: • The causes for neonatal thrombocytopenia (NT) are well known. • The effects of platelet transfusions (PT) and its indications are still a matter of debate and recommendations differ widely. What is New: • The duration of NT is positively related to the severity of NT and the number of subsequent PT. • The mortality rate is not associated with the severity of NT but increases with increasing numbers of PT and in the case of relevant intraventricular hemorrhage (≥ grade II), PT does not influence the mortality rate.

Risk Factors For Severity Of Thrombocytopenia In Full Term Infants: A Single Center Study

“…In our study, there were no statistically significant differences between duration of hospital stay and severity of NT, which did not agree with Resch et al [23], as they found the duration of NT is positively related to the severity of NT and the number of subsequent platelet transfusions.…”

“…Furthermore in our study, most cases of NT in term infants were late onset (after 72hours of life) in about two-thirds of the cases. This was not in agreement with another study in which the majority (84.1%) had early onset NT, but 76% of cases were born preterm [9].…”

“…In a study by Resch et al [9], a mortality rate of 10.8% was significantly associated with signs of bleeding (P < 0.05) and correlated with an increasing number of platelet transfusions (P < 0.05), but not with the severity of NT (P = 0.4). Furthermore, results from studies by Baer et al [6] and Resch et al [23] found no relationship between the lowest platelet count recorded and the mortality rate; however, a direct relationship was observed between the number of platelet transfusions received and the mortality rate. In our study, two-thirds of cases with severe NT received at least once platelet transfusion.…”

“…However, NT in full term (FT) infants occurs less frequency than in preterm infants, as it was 2% in one study cohort [8]. Moreover, the main risk factors in term infants were placental insufficiency, NAT and occult infection, which differs from preterm rick factors such as sepsis, TORCH infection, and NEC [9].…”

Development and Validation of Early Warning Criteria to Identify Escalated Care Events in Neonatal Intensive Care Unit Patients

“…To ensure robustness of ECE, we checked the association of the final set of ECE with clinically relevant outcomes in the published literature. [23][24][25][26][27][28][29][30][31][32][33][34]…”