A prospective observational study of thrombocytopenia in high risk neonates in a tertiary care teaching hospital

Anubha Sharma,Karuna Thapar

doi:10.4038/sljch.v44i4.8045

Abstract

Objective: To study the incidence, associated risk factors and outcomes of thrombocytopenia in a group of high risk neonates admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary care teaching hospital. Method: A prospective observational study was carried out in the NICU of Sri Guru Ram Dass Institute of Medical Sciences and Research, Amritsar on 100 high risk neonates (intramural + extramural) enrolled consecutively from January to July 2013. Babies of parents who refused to sign the consent form were excluded from the study. Gestational age was calculated by obstetrical estimate according to last menstrual period, combined with ultrasound and/or Ballard scoring. Enrolled neonates were observed prospectively and a platelet count was done at presentation, and subsequently, as and when required. The outcomes of the high risk neonates with thrombocytopenia were assessed. Statistical analysis (Chi square test) was done to find out the association of the risk factors with neonatal thrombocytopenia. Results: The study population comprised 84 males and 16 females. There were 55 preterm babies and 66 low birth weight babies. There were 11 babies with necrotising enterocolitis, 35 with perinatal asphyxia, 32 with maternal risk factors, 56 with respiratory risk factors, 66 with sepsis, 11 with twin deliveries, 41 with small for gestational age / intrauterine growth retardation (SGA/IUGR), 20 with jaundice, 10 with congenital defects / syndromes and 4 with ABO incompatibility. Incidence of thrombocytopenia among the high risk neonates was 55%. Perinatal asphyxia (P=0.015), maternal risk factors (P=0.006), respiratory risk factors (P=0.035), sepsis (P=0.016) and SGA/IUGR (P=0.008) were significantly associated with thrombocytopenia. During the study period 8 (14.5%) cases with thrombocytopenia died, 5 (9%) developed intraventricular haemorrhage and 11 (20%) had frank bleeding. Of the 55 high risk neonates with thrombocytopenia 21 (38%) received platelet transfusions and of them 11 (52%) showed improved platelet counts and 4 (19%) died. Conclusion: Thrombocytopenia occurred in 55% neonates admitted to NICU. Perinatal asphyxia, maternal risk factors, respiratory risk factors, sepsis and SGA/IUGR were significantly associated with thrombocytopenia. Sri Lanka Journal of Child Health, 2015: 44 (4): 213-219

Highlights

A healthy neonate, even a preterm, has the same mean platelet count as adults and a platelet count less than 150,000/cu mm is defined as thrombocytopenia[1]
Of the 55 high risk neonates with thrombocytopenia 21 (38%) received platelet transfusions and of them 11 (52%) showed improved platelet counts and 4 (19%) died
Thrombocytopenia occurred in 55% neonates admitted to Neonatal Intensive Care Unit (NICU)

Summary

Introduction

A healthy neonate, even a preterm, has the same mean platelet count as adults and a platelet count less than 150,000/cu mm is defined as thrombocytopenia[1]. Some authors categorize platelet counts less than 30,000 per cu mm as severe thrombocytopenia[4]. Common fetal causes of thrombocytopenia are alloimmune, congenital infections, aneuploidy and autoimmune[4]. Onset thrombocytopenia is usually secondary to placental insufficiency [e.g. intrauterine growth retardation (IUGR), diabetes, perinatal asphyxia, disseminated intravascular coagulation (DIC), alloimmunity and autoimmunity, congenital infections, thrombosis, bone marrow replacement, metabolic diseases and congenital/inherited syndromes]4. The most common cause of severe thrombocytopenia in neonates is immune thrombocytopenia from antiplatelet antibodies across placenta[5]. Low platelet count in an otherwise healthy term newborn is due to neonatal alloimmune thrombocytopenia (NAIT) until proven otherwise[4]

Methods

Results

Conclusion