Severe Thrombocytopenia Predicts Outcome in Neonates with Necrotizing Enterocolitis

Kenton, Alexander B.; O'Donovan, Donough J; Cass, Darrell L.; Helmrath, Michael A.; Smith, E. O’Brian; Fernandes, Caraciolo J.; Washburn, Kimberly K.; Weihe, Elizabeth; Brandt, Mary L.

doi:10.1038/sj.jp.7211180

Cited by 71 publications

(41 citation statements)

References 56 publications

(57 reference statements)

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“…However, in more mature infants with NEC, low leukocyte counts were associated with increased mortality. 15 Platelet counts have been described to be significantly lower in non-survivors, 16 and correlated with adverse outcome when below 100 Â 10 9 /l. 4,16 Even though we observed a tendency toward lower platelet counts in more severe NEC and in non-survivors, the differences were not statistically significant, as was also found in some other studies.…”

Section: Discussionmentioning

confidence: 99%

“…15 Platelet counts have been described to be significantly lower in non-survivors, 16 and correlated with adverse outcome when below 100 Â 10 9 /l. 4,16 Even though we observed a tendency toward lower platelet counts in more severe NEC and in non-survivors, the differences were not statistically significant, as was also found in some other studies. 3,14 Nevertheless, the AUC for prediction of poor outcome was 0.59 and inclusion of platelet count into the NECscore increased its predictive power.…”

Section: Discussionmentioning

confidence: 99%

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A simple presurgical necrotizing enterocolitis-mortality scoring system

et al. 2006

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Objective: To assess the relationship between early laboratory parameters, disease severity, type of management (surgical or conservative) and outcome in necrotizing enterocolitis (NEC). Study design:Retrospective collection and analysis of data from infants treated in a single tertiary care center (1980 to 2002). Data were collected on disease severity (Bell stage), birth weight (BW), gestational age (GA) and pre-intervention laboratory parameters (leukocyte and platelet counts, hemoglobin, lactate, C-reactive protein).Results: Data from 128 infants were sufficient for analysis. Factors significantly associated with survival were Bell stage (P<0.05), lactate (P<0.05), BW and GA (P<0.01, P<0.001, respectively). From receiver operating characteristics curves, the highest predictive value resulted from a score with 0 to 8 points combining BW, Bell stage, lactate and platelet count (P<0.001). At a cutoff level of 4.5 sensitivity and specificity for predicting survival were 0.71 and 0.72, respectively.Conclusion: Some single parameters were associated with poor outcome in NEC. Optimal risk stratification was achieved by combining several parameters in a score.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A simple presurgical necrotizing enterocolitis-mortality scoring system

et al. 2006

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“…There have been additional concerns about adverse reactions to platelet transfusions in neonates. There are reports suggesting an association between repeated platelet transfusions and adverse events such as hepatic dysfunction following necrotising enterocolitis [11]. Furthermore, one neonatal study demonstrated an increased incidence of bacterial infection from 5% in non-thrombocytopenic neonates to 45% in neonates who received >10 platelet transfusions [3].…”

Section: Risks and Benefits Of Plateletsmentioning

confidence: 99%

Platelets for Neonatal Transfusion - Study 2: A Randomised Controlled Trial to Compare Two Different Platelet Count Thresholds for Prophylactic Platelet Transfusion to Preterm Neonates

et al. 2014

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Introduction: Neonatal thrombocytopenia is a common and important clinical problem in preterm neonates. A trial assessing clinically relevant outcomes in relation to the different platelet count thresholds used to trigger transfusion has never been undertaken in preterm neonates with severe thrombocytopenia. Objectives: Platelets for Neonatal Transfusion - Study 2 (PlaNeT-2) aims to assess whether a higher prophylactic platelet transfusion threshold is superior to the lower thresholds in current standard practice in reducing the proportion of patients who have a major bleed or die up to study day 28. Methods: PlaNeT-2 is a two-stage, randomised, parallel-group, superiority trial. PlaNet-2 compares clinical outcomes in preterm neonates (<34 weeks' gestation at birth) randomised to receive prophylactic platelet transfusions to maintain platelet counts at or above either 25 × 10⁹/l or 50 × 10⁹/l. The primary outcome measure is the proportion of patients who either die or experience a major bleed up to and including study day 28. A total of 660 infants will be randomised. Results and Conclusions: This trial will help define optimal platelet transfusion support for severely thrombocytopenic preterm neonates by evaluating the risks and benefits of two different prophylactic neonatal platelet transfusion thresholds.

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“…A total of 52% were female and 48% were male; seven infants (15.9%) were full-term neonates. Mean birth weight was 1,666 ± 740 g (range 710-3,450) and mean gestational age was 32 ± 4 weeks (range of [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Twenty-two percent were extremely low birth weight (ELBW, birth weight under 1,000 g).…”

Section: Resultsmentioning

confidence: 99%

Low mortality in necrotizing enterocolitis associated with coagulase-negative Staphylococcus infection

et al. 2008

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The aim of this study was to correlate the clinical course of necrotizing enterocolitis (NEC) with infection by coagulase-negative Staphylococcus at the onset of the illness. Records of all newborn infants developing NEC between January 1998 and December 2001 were reviewed. NEC was classified according to the criteria of Bell et al. Numeric variables were described by standard statistical methods. Comparisons between subgroups were performed by parametric statistical tests. Forty-four patients developed NEC stage II (n = 25) or III (n = 19). The incidence was 0.024% of live births in the hospital, and the mortality rate was 9%. The main risk factor was prematurity (84%). Only one-fourth of the patients had gastric residuals. A platelet count of <100,000 cells/mm3 occurred only in grade III NEC. Blood cultures were positive in 34% of the patients. The predominant organism (73%) was coagulase-negative Staphylococcus (CoNS). Neither Clostridium nor Bacteroides species were isolated. Stage II patients were maintained nothing per os (NPO) for 9 +/- 3 days and received antibiotics for 10 +/- 3 days. All of the stage III patients required an operation. In one-third of them, primary peritoneal drainage was initially performed but all required further operative procedures. We report a low incidence and mortality rate of necrotizing enterocolitis. Thrombocytopenia is confirmed as a marker of severity. Positive blood cultures for CoNS may explain, at least in part, the low mortality reported.

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Severe Thrombocytopenia Predicts Outcome in Neonates with Necrotizing Enterocolitis

Abstract: Severe thrombocytopenia within the first 3 days after a diagnosis of NEC suggests a higher likelihood of bowel gangrene, morbidity, and mortality. Prospective studies of infants with early and severe thrombocytopenia may help determine the optimal timing of laparotomy in infants with NEC.

Cited by 71 publications

References 56 publications

A simple presurgical necrotizing enterocolitis-mortality scoring system

A simple presurgical necrotizing enterocolitis-mortality scoring system

Platelets for Neonatal Transfusion - Study 2: A Randomised Controlled Trial to Compare Two Different Platelet Count Thresholds for Prophylactic Platelet Transfusion to Preterm Neonates

Low mortality in necrotizing enterocolitis associated with coagulase-negative Staphylococcus infection

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