Thrombocytopenia-related outcome and pattern in preterm neonates hospitalized in neonatology unit: A single-center experience

Abstract

Abstract: BACKGROUNDS: In preterm newborns, thrombocytopenia is one of the most often observed hematologic findings. Most cases of thrombocytopenia are mild to moderate, self-limiting, and have a short duration; nevertheless, in rare cases, it can result in serious complications including pulmonary hemorrhage that lead to death and morbidity. OBJECTIVES: The objective of this study was to identify the pattern, risk factors, and outcome of thrombocytopenia in preterm neonates hospitalized in a tertiary-level neonatal intensive care unit (NICU). PATIENTS AND METHODS: All sick preterm neonates who developed thrombocytopenia within the first 28 days of life admitted to the NICU were included. A platelet count was performed at presentation time and as needed after that. Thrombocytopenia-related morbidities (intraventricular hemorrhage, pulmonary hemorrhage, and sepsis), mortality, and risk factors were analyzed concerning severity (mild, moderate, and severe) and age of thrombocytopenia onset (early and late) in preterm neonates. RESULTS: A total of 100 preterm neonates were admitted to our NICU. Of these, 48% of neonates developed thrombocytopenia. In terms of severity, mild, moderate, and severe thrombocytopenia were present in 62.5%, 37.5%, and 16.7% of newborns, respectively. The prevalent risk factors for late-onset thrombocytopenia (LOT) were necrotizing enterocolitis (NEC) and late-onset sepsis; for early-onset thrombocytopenia, the risk factors were pregnancy-induced hypertension and early-onset sepsis. Neonates with sepsis, severe birth asphyxia, and NEC were significantly associated with severe thrombocytopenia (P < 0.001). Thrombocytopenia-related morbidities and mortality were significantly higher among moderate-to-severe thrombocytopenia cases (P < 0.001). CONCLUSIONS: Sepsis was the most common risk factor associated with severe and LOT. Compared to mild/moderate thrombocytopenia, severe thrombocytopenia required more platelet transfusions, was associated with major bleeding manifestations, and had a higher mortality rate. When caring for premature newborns, these issues need to be taken into account.