THROMBOCYTOPENIA IN NEONATAL SEPSIS: TIME RELATIONSHIP BETWEEN CLINICAL SIGNS, DETECTION OF THROMBOCYTOPENIA AND POSITIVE BLOOD CULTURE

Abstract

Thrombocytopenia is a common manifestation of bacterial sepsis in children. A prospective study was designed to investigate the time relationship between the clinical manifestations of sepsis, detection of thrombocytopenia and the confirmation of a positive blood culture. Three groups of neonates admitted to special care were studied. Group I (16 pts) had sepsis confirmed by positive blood cultures. Group II (63 pts) were suspected to be septic but blood cultures were negative. Group III (28 pts) were randomly selected sick neonates without suspected or confirmed sepsis. Platelet counts by phase microscopy were done at the time of septic work-up and at 12, 24, 48 and 72 hours in Groups I and II and at similar intervals in Group III. Thrombocytopenia, platelets < 100,000/mm3, were found in 63% of Group I, none in Group II and in 18% of Group III. At the above time intervals comparisons of platelet counts between Groups I and II, and I and III showed statistically significant differences at all times (p < 0.05). In Group I thrombocytopenia was detected at 8 ± 12 hours while the positive blood cultures were confirmed at 43 ± 27 hours with p<0.005. This study confirms that thrombocytopenia is frequently associated with bacterial sepsis in neonates, although less frequently it may be present in clinical entities other than sepsis. The rapid appearance of thrombocytopenia, long before the confirmation of a positive blood culture, makes this test a valuable adjunct to management of septic neonates.