Organism-specific platelet response and factors affecting survival in thrombocytopenic very low birth weight babies with sepsis

Abstract

Objective: To study organism-specific platelet response and factors affecting survival in thrombocytopenic very low birth weight (VLBW) babies with sepsis.Study Design: Very low birth weight babies (birth weight <1500 g) admitted to a single level-three intensive care unit from January 2000 to December 2005 were prospectively evaluated for sepsis by rapid screen test, blood counts and blood culture. In thrombocytopenic babies, organismspecific platelet response and its effect on various platelet parameters were evaluated. In addition, morbidity, mortality and factors affecting survival were studied.Result: Sepsis was diagnosed in 230 of 620 (37%) patients. Grampositive sepsis occurred in 20% (46/230), Gram-negative in 71% (164/ 230) and fungal in 8.6% (20/230) of patients. Thrombocytopenia was observed in 67% (155/230) of babies. The frequency and duration of thrombocytopenia were more with Gram-negative and fungal infections. The incidence of persistent bacteremia, multiorgan failure and death was more in thrombocytopenic neonates (P<0.01). The incidence of multiorgan failure and death was directly related to the duration of thrombocytopenia. On multiple logistic regression analysis, poor prognostic factors include a high SNAP score at admission, a severe drop in platelet count at onset of sepsis, a low platelet nadir, a prolonged duration of thrombocytopenia, a need for platelet transfusion, less number of days off ventilation and a prolonged stay in the hospital. Conclusion:In thrombocytopenic VLBW babies with sepsis, organismspecific platelet response is seen. In addition, persistent bacteremia, multiorgan failure and death are more in these babies, and survival decreases with the increased severity and duration of thrombocytopenia, with prolonged ventilation and increased need for platelet transfusions

Challenging issues in neonatal candidiasis

“…The fall in platelet count is 50% in fungemia cases, nearly 40% in gram-negative, and 25% in grampositive bacteremia cases. Other studies concur that it may not be organism specific although it is common with ICI 4,5 . The same authors have proposed using the following risk factors alone or in combination to determine therapy: gestational age, exposure to third-generation cephalosporins in the previous 7 days, and thrombocytopenia 6 .…”

Platelet Indices as Predictive Markers of Prognosis in Pediatric Septic Shock Patients

“…Further, we did assess the effects of microorganisms on platelet counts. Microorganisms have been shown to alter platelet responses in both very low birth weight infants (25,26) and adults (14). How- ever, microorganism growth was documented in few of these patients.…”

Effect of Severe Maternal Iron Deficiency Anemia on Neonatal Platelet Indices

“…Largesized platelets denote high metabolic activity and often have been reported in association with neonatal sepsis [20,21]. Several authors documented organism-specific changes in thrombocytes [20,22,23]. Larger platelet size has also been associated with poor prognosis in neonatal sepsis [21,24], or septic shock in older age group [25].…”