Neonatal Thrombocytopenia Research Articles

Vancomycin-related thrombocytopenia in neonates

Background With the improvement of neonatal care in the country and survival of the preterm infants and sick neonates, many arising problems are being observed. One of these is the significant presence of neonatal thrombocytopenia and the need for lots of platelet transfusions per an infant. Many neonatal factors can cause thrombocytopenia, but we observed severe, prolonged thrombocytopenia in infants who received specifically vancomycin for sepsis or other medical/surgical conditions. Literature search revealed that vancomycin can cause immune thrombocytopenia by inducing platelet antibodies, though this is scarcely described in neonates. Participants and methods This is a hospital-based longitudinal study held in NICU during February 2017 to February 2019. All admitted neonates (term and preterm) who received vancomycin were involved, but those with maternal thrombocytopenia, systemic lupus erythematosus (SLE), maternal eclampsia/HELLP (Haemolysis, Elevated Liver enzymes, Low Platelets) syndrome, and Intr Uterine Growth Rrestriction (IUGR) were excluded. Results Of 117 infants admitted in this period, 68 infants fulfilled the inclusion criteria. The severe decline in platelet count observed on the second to third day of vancomycin treatment continued throughout the treatment and started to rise 2–3 days after discontinuation. During treatment with vancomycin, platelet transfusion 2–3 times a day was observed not to raise platelet level significantly, but it prevented serious bleeding. Conclusion Vancomycin-induced thrombocytopenia in neonate is a rising new problem in NICUs. The authors may need to add adjunctive intravenous immunoglobulins or methylprednisolone or change the dosing system to smaller frequent doses, given over longer time, to overcome this serious problem.

Prevalence of Thrombocytopenia in Neonates Born to Mothers with Pregnancy Induced Hypertension

Background: Pregnant women with hypertension are at high risk to deliver a newborn with severe thrombocytopenia. Little is known concerning the magnitude of thrombocytopenia in neonates born to mothers with PIH and controversy was also present. Objective: To determine the frequency of thrombocytopenia in neonates born to mothers with pregnancy induced hypertension. Material & Methods: This cross sectional study was carried out at department of Neonatology, Lady Aitcheson Hospital, Lahore for 6 months. A sample of 1ml from cord blood was taken and sent to hematology laboratory. Neonatal thrombocytopenia was labeled. All the data was entered and analyzed on SPSS version 16. Results: The mean age of babies was 13.31±7.07 days. The male to female ratio was 1.1:1. The mean platelet count of the babies was 150.23±29.39. Thrombocytopenia was present in 41.50% babies. Conclusion: Prevalence of thrombocytopenia was 41.5% in females with PIH. Keywords: Thrombocytopenia, Pregnancy Induced Hypertension, Mothers, Neonates, Neonatal Intensive care unit

Incidence and Risk Factors for Neonatal Thrombocytopenia among Newborns admitted to Neonatal Intensive Care Unit of Assiut University Children's Hospital-A Prospective Observational Study

Incidence and Risk Factors for Neonatal Thrombocytopenia among Newborns admitted to Neonatal Intensive Care Unit of Assiut University Children's Hospital-A Prospective Observational Study

Deteksi antibodi trombosit spesifik anti-hpa-3 pada neonatus dengan trombositopenia

Background: The immune factor causing thrombocytopenia in neonates can occur even during pregnancy. Antigen discrepancies in the platelet membrane expressed by the fetus and maternal can be the cause of thrombocytopenia. This is due to the presence of anti-platelet antibodies produced by the maternal body as a form of immune response after exposure to antigens on the platelet membrane expressed by the fetus. Human platelet antigen detection has not been carried out in Indonesia, there is no known antigen on the platelets. This allows the occurance of alloimmune thrombocytopenia in neonates, one of sign that can be recognized through clinical symptoms was neonates with thrombocytopenia. Screening anti-platelet antibodies in neonates with thrombocytopenia is an effort to find the possibility of anti-human platelet antigen antibodies. 
 Objective: The aim of this study is to find out the presence of anti-platelet antibodies in neonates with thrombocytopenia.
 Methods: The study is descriptive observational with cross sectional design. The subject in this study were neonates with thrombocytopenia according to the study criteria. The collected sample is screened for the presence of anti-platelet antibodies, then identification of anti-HPA antibodies.
 Results: Screening in 30 neonates showed that 3 neonatal positive anti-platelet antibodies, 2 with borderline and 25 negative anti-platelet antibodies. Identification of anti-platelet antibodies was performed in five samples (result of screening, three with positive screening and two borderline), indicating that all were negative for the anti-human platelet antigen antibody GPIIb/IIIa specific HPA-3. 
 Conclusion: Based on the screening result, five samples were found to have anti-platelet antibodies in neonates with thrombocytopenia, but after identification none of them were found to be specific anti-HPA antibodies to GPIIb/IIIa.

Neonatal thrombocytopenia: A review. II. Non-immune thrombocytopenia; platelet transfusion.

Non-immune thrombocytopenia is caused by multiple pathologies; the most common causes are extra- or intrauterine infections, whereas secondary cases result from other pathologies involved in the fetal-placentalmaternal interface. This second article lists its causes and provides details of the different pathologies. Platelet transfusion is widely used in neonatology, both as treatment and as bleeding prophylaxis. However, there is no general consensus about the platelet count threshold that is convenient to indicate a transfusion or actual indications. Recent articles are commented regarding the different proposed strategies. The emphasis is on discussing the multiple adverse effects of platelet transfusions because knowledge about them is changing the paradigm for indications, suggesting that a much more restrictive policy is required.

Incidence and Risk Factors of Thrombocytopenia in Neonates Admitted with Surgical Disorders to Neonatal Intensive Care Unit of Tikur Anbessa Specialized Hospital: A One-Year Observational Prospective Cohort Study from a Low-Income Country.

BackgroundThrombocytopenia is one of the most common hematologic disorders affecting neonates admitted to the neonatal intensive care unit. The aim of this study was to determine the incidence and associated risk factors of neonatal thrombocytopenia in neonates admitted with surgical disorders.MethodsAn observational prospective cohort study was conducted and all neonates admitted to neonatal intensive care unit of Tikur Anbessa Specialized Hospital with surgical disorders were included. Data were collected using a checklist and analyzed by SPSS version 23. Chi square test and independent sample t- test were used to assess the association among different variables.ResultsA total of 210 neonates were included in the study, out of which 56.2% were males. The incidence of thrombocytopenia was 55.8%. Among neonates with thrombocytopenia, 90.9% had late onset thrombocytopenia and half were in the severe range (<50,000/µL). The presence of sepsis (P = 0.000) and atresia (P = 0.000) were found to be significantly associated with the development of thrombocytopenia. The mean non feeding hours were found to be significantly longer for patients with thrombocytopenia (t [199], 5.81, P = 0.000).ConclusionThe incidence of thrombocytopenia is high in our institution. Prevention methods towards neonatal sepsis should be given due emphasis.

Effect of Pregnancy on the Clinical Course of ITP Pregnant Women and Their Newborns. Resuts of a Spanish Case Series of 297 Primary ITP Pregnancies

Introduction:Given that there is no large case-series, effect of pregnancy on the course of pre-existing primary immune thrombocytopenia (ITP) patients is unclear1,2. Furthermore, outcome predictors evidence of neonates born to mothers with ITP is very scarce1. Due to obvious ethical reasons, no clinical trial regarding ITP and pregnancy has been reported until recent days3. Nevertheless, the relationship between ITP and pregnancy is considered a “trending topic” nowadays. As it is the, until now, unknown safety and efficacy of new drugs as TPO mimetics in this setting3-6.Aims:To evaluate outcome and global management of pregnancy and delivery on ITP women an on their offspring.Methods:Primary ITP was defined as a platelet count < 100 x 109/L in the absence of other causes or disorders that may be associated with thrombocytopenia.All women diagnosed of primary ITP from 2011 to 2016 in 24 Spanish Hematology Departments who had at least one pregnancy after ITP onset were included in this registry.Results:We included 297 primary ITP pregnancies from 204 women. At pregnancy diagnosis, we observed a majority of chronic ITP cases (71.9 %). At ITP diagnosis, median age of our case-series was 23 years (IQR, 18-31) and median platelet count was 18 x 109/l (IQR, 6-36). Median time from ITP diagnosis to pregnancy was 162 months (IQR, 0-364). Median number of pregnancies prior to ITP diagnosis was 1 (IQR, 0-2) with 1 pregnancy (IQR, 1-2) after ITP diagnosis as a median.51.6% of women received corticosteroids, immunoglobulins (IVIG) (16.6%), rituximab (7.1%) and/or splenectomy (8.7%) as ITP treatments between or before new pregnancies. On the other hand, 26.5% of women needed treatment for ITP during pregnancy, mainly steroids (13.9%) and IVIG (10.2%).The median platelet-count nadir during pregnancy was 73 x 109/l (IQR, 31-174). 135 (45.4%) pregnancies had less than 50 x 109 platelets/l with 77 (25.9%) with less than 30 x 109 platelets/l. 57 women (19.2%) exhibited hemorrhagic symptoms, being 30 (10.1%) of them severe bleedings.Regarding type of delivery, this was vaginal in 187 (62.9%) of pregnancies. Median platelet count at delivery was 111 x 109/l (IQR, 70-187). 47 patients (15.8 %) experienced 60 bleeding episodes. We only observed 52 cases (19.5%) of neonatal thrombocytopenia among 266 living newborns.Conclusions:Our results are comparable to previously reported1,2. No severe bleeding complications during pregnancy and/or delivery were observed in our study. Rate of neonatal thrombocytopenia, and therefore, newborn bleeding is low. DisclosuresNo relevant conflicts of interest to declare.

A meta-analysis of neonatal outcomes in pregnant women with immune thrombocytopenic purpura.

Thrombocytopenia is an autoimmune disorder characterized by reduced platelet counts. Neonatal thrombocytopenia incidence has been linked with immune thrombocytopenic purpura in mothers during pregnancy, possibly because antiplatelet antibodies can cross the placental barrier. To date, no study has attempted to evaluate the actual prevalence of neonatal thrombocytopenia in infants born to mothers with immune thrombocytopenic purpura. In this meta-analysis of the available literature, we attempt to fill this gap. We want to evaluate the overall prevalence of neonatal thrombocytopenia, its severity, and the incidence of hemorrhage in infants with thrombocytopenia born from mothers with immune thrombocytopenic purpura. Adhering to PRISMA guidelines, we systematically scanned four academic databases including EMBASE, CENTRAL, Scopus, and MEDLINE to identify relevant literature. We performed a meta-analysis to summarize thrombocytopenia incidence rate and severity in newborn infants of mothers with immune thrombocytopenic purpura. We identified 21 eligible studies involving 1951 mothers and 1844 neonates. Meta-analysis showed high prevalence for neonatal thrombocytopenia (24%). Within these, severe cases were the most prevalent (41.2%), followed by moderate (37.7%) and mild (17.6%) cases. Hemorrhage was only reported in 4.1% of the observed neonatal thrombocytopenia cases. This review provides preliminary evidence that neonatal thrombocytopenia incidence is high in infants born to mothers with immune thrombocytopenic purpura. This study further reports that the largest proportion of these cases are severe.

Neonatal thrombocytopenia: A review. I. Definitions, differential diagnosis, causes, immune thrombocytopenia.

Thrombocytopenia, defined as a platelet count below 100 x 109/L, is a very common finding in the neonatal period, especially in critically ill infants and preterm newborns. Its causes are multiple: it may be due both to pediatric conditions and to other factors involved in the fetal-placental-maternal interface. This initial article describes the causes of thrombocytopenia, proposes a diagnostic approach to manage a thrombocytopenic newborn infant, and provides a detailed description of the different conditions corresponding to thrombocytopenia of immune etiology. It also describes the different causative mechanisms and reviews the varying characteristics of thrombocytopenia secondary to maternal immune thrombocytopenia and neonatal alloimmune thrombocytopenia. The different treatment approaches to each of the different conditions are described both for their pre- as well as their postnatal management. The severity of thrombocytopenia and the serious complications and sequelae associated with the neonatal alloimmune thrombocytopenia are highlighted.

PREVALENCE AND OUTCOME OF THROMBOCYTOPENIA AND ITS CORRELATION WITH CRP IN NEONATAL INTENSIVE CARE UNIT

Introduction: Neonatal thrombocytopenia, one of the most common hematological abnormalities in neonates particularly in premature and sick neonates. The aim of this study to study the prevalence and outcome of Thrombocytopenia and its correlation with CRP in the neonatal intensive care unit. Objectives: 1. To nd the prevalence of Thrombocytopenia in the Neonatal intensive care unit in King George Hospital. 2. Factors that predisposing to Thrombocytopenia in neonates 3. Outcomes of thrombocytopenia in neonates. 4. Correlation of thrombocytopenia with the C-reactive protein (CRP) in neonates. Materials And Methods: It is a cross -sectional study in 80 Newborns less than or equal to 28 days admitted in NICU, king George hospital, Visakhapatnam from JANUARY 2019 to JUNE 2020 over period of 18 months. Data is collected from the medical records. Results: The prevalence of thrombocytopenia in this study is 40% with early-onset thrombocytopenia being 65% whereas, that of late-onset thrombocytopenia is 35% ,strong assosciation is found between thrombocytopenia and sepsis ,with mild to moderate variety being (86.4%) and (40%) of severe thrombocytopenia group. Of 80 newborns ,90% of severely thrombocytopenic group have positive CRP, whereas it is 40.9% in the mild to moderate group and 1.4% in normal group.40% of severe thrombocytopenic group had elevated PT, APTT, INR. There was higher proportion of bleeding (45.5%) in severe thrombocytopenia group. gastrointestinal bleeding constituted for 36.4% and intracranial bleeding 2.1% . Conclusion: Positive septic workup is signicantly association with thrombocytopenia, CRP was signicantly association with thrombocytopenia in this study

Immune and Non-Immune Etiology of Thrombocytopenia: Neonatal and Maternal Causes

Neonatal thrombocytopenia (NT) is a common hemostatic abnormalitiy among newborn in the NICU, which increases with the degree of prematurity. It is well documented that this disease has a large range of feasible etiologies. Prematurity, early and late-onset sepsis and asphyxia are the most usual causes of NT. Moreover, FNAIT is the major risk for intracranial hemorrhage in the fetus or newborn. Here, we reviewed the causes for NT, in both newborns and mothers. We demonstrated the factors associated with NT in the newborn including placental insufficiency, fetal and neonatal alloimmune thrombocytopenia (FNAIT), prematurity, sepsis, and asphyxia. The causes of thrombocytopenia in pregnant women and its impact on newborns were also described. This review showed that gestational thrombocytopenia was the most common cause of thrombocytopenia with an incidence of 70-80%, followed by preeclampsia, HELLP and ITP. But neonates born to mothers with immune thrombocytopenia (ITP) had a higher risk for NT and hemorrhagic problems. In ITP, neonatal platelets are destroyed by maternal autoantibodies. We reviewed the causes of thrombocytopenia in neonates and mothers in two groups of immune and nonimmune factors. However, it seems that immunological factors are the most severe form of NT. However, it is necessary to separate NT etiology for differential diagnosis.

Клінічний випадок вагітності, ускладненої гепариніндукованою тромбоцитопенією, у жінки з синдромом Еванса

The simultaneous development of autoimmune hemolytic anemia and immune thrombocytopenia is known as Evans syndrome. This pathology is extremely rare during pregnancy, requires careful differential diagnosis and is associated with a high risk of hemorrhagic and thromboembolic complications. Treatment approaches for autoimmune hemolytic anemia and immune thrombocytopenia are similar, but in the case of autoimmune hemolytic anemia, thromboprophylaxis is mandatory. Heparin-induced thrombocytopenia is a serious adverse event of anticoagulation. One presents with a decrease in platelets but a paradoxical increase in thrombotic risk and mandates switching of the anticoagulant agent to a non-heparin one. Clinical case. We describe the case of pregnancy complicated with Evans syndrome and development of heparin-induced thrombocytopenia at 28 weeks. Treatment of the underlying disease was effective on the use of first-line therapy. Fondaparinux and vitamin K antagonist (warfarin) have been used to treat heparin-induced thrombocytopenia. Monitoring of the fetal condition is carried out with careful control of Doppler ultrasound of the middle cerebral artery. Successful change of anticoagulant, close surveillance and carefully selected therapy allowed to achieve a successful termination of pregnancy. A healthy female newborn with body weight 2450 g, 8–8 Apgar scores was vaginally delivered uneventful at the 38th week. There were neither neonatal thrombocytopenia nor anemia. During the year after birth, the woman's condition is not worse, the child develops according to age. An analysis of similar cases of pregnancy from the literature is described. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: thrombocytopenia, hemolytic anemia, pregnancy, Evans syndrome, heparin-induced thrombocytopenia.

Evaluation of Some Maternal and Neonatal-Associated Risk Factors in Early On-Set Neonatal Thrombocytopenia in Delta State, Nigeria

Evaluation of Some Maternal and Neonatal-Associated Risk Factors in Early On-Set Neonatal Thrombocytopenia in Delta State, Nigeria

Neonatal thrombocytopenia and associated factors

Background: The aim is to study neonatal thrombocytopenia and associated factors and compare the results with recent studies in neonates with thrombocytopenia admitted in neonatal intensive care unit (NICU).Methods: After taking detailed consent from parents/guardians, detailed maternal obstetrics and neonatal history were taken and complete physical examination was done and details of the investigations done and outcome was noted and evaluated. Relevant data was entered in the predesigned proforma and was analyzed. Immediate outcome was assessed by outcome or death.Results: The most common cause of neonatal thrombocytopenia was preterm gestational age. There were 68 (27.2%) neonates in the age group 28-32 weeks, 107 (42.8%) were in the age group 32-37 weeks and 75 (27.2%) were in the age group 37-42 weeks. Majority of the neonates were in the age group 32-37 weeks. We assessed outcome which was as follows, 98 (39.2%) neonates had expired and 152 (60.8%) neonates had survived in our study.Conclusions: We studied the etiology of neonatal thrombocytopenia and associated factors. The most common cause of neonatal thrombocytopenia found was preterm gestational age. The most common type of neonatal thrombocytopenia found in our study was moderate to severe thrombocytopenia. In our study, there was 39.6% was neonatal death rate. In our study, neonatal thrombocytopenia was associated with the following factors gestational age, intrauterine growth retardation, pre-eclampsia, multiple pregnancy, eclampsia, birth asphyxia, x-ray chest/abdomen, ultrasonography (USG) abdomen, USG cranium, liver function tests and renal function tests.

Clinical profile of thrombocytopenia in pregnancy

Thrombocytopenia is defined as platelet count of less than normal for the laboratory. This typically is at or very close to1.5 lakh/cumm. Hence platelet count of less than 1.5 lakh/cumm is called as thrombocytopenia. Thrombocytopenia in pregnancy is not an uncommon finding; in fact, it is the second most common hematological disorder in pregnancy after anaemia and affects nearly 6 to 15%; on an average 10% of all pregnancies. The reported prevalence of maternal thrombocytopenia is variable. In a recent survey in 2000 involving 6770 pregnant women, prevalence of thrombocytopenia was found to be 11.6%. A prospective observational study conducted to identify causes for thrombocytopenia in pregnancy along with its neonatal outcome Out of total, 30% patients delivered low birth weight babies and 70% delivered babies with birth wt of >2.5kg. Occurrence of low birth weight babies in mothers with GT and ITP were comparable being 27.3% and 33.3% respectively. APGAR score (at 1 min) of neonates was less than 7 in 12% neonates while at 5 min it was below 7 in only 1(2%) baby. Neonates born to mothers with ITP had poor 1 minute APGAR score when compared to neonates born to patients with GT. There was no significant relationship found between maternal and fetal platelet counts in patients with gestational thrombocytopenia. ITP leads to neonatal thrombocytopenia. Keywords: Cord blood, Thrombocytopenia, APGAR scoring, ITP, Gestational thrombocytopenia.

Clinical features and outcomes of neonatal dengue at the Children's Hospital 1, Ho Chi Minh, Vietnam.

Objectives Neonatal dengue has been reported in the literature with contradictory findings of clinical characteristics and diagnosis; thereby, misdiagnosis of neonatal dengue has been frequently reported. We aim to delve into the epidemiology, clinical features, and outcomes of neonatal dengue, thus avoid misdiagnosis and obtain early intervention. Study design A retrospective study was conducted at Children's Hospital 1, Ho Chi Minh, Vietnam with laboratory-confirmed dengue in neonates by positive viral antigen nonstructural protein one rapid test (NS1) and positive IgM antibody for dengue by MAC-ELISA. Results We have included 32 neonates in this study with 25% cases were misdiagnosed with neonatal sepsis, and 12.5% cases were misdiagnosed with neonatal immune thrombocytopenia at the beginning. The median time between the first day of the mother's onset of fever and childbirth was -1 days (IQR: -2, 2). The patient's clinical manifestation included: petechiae 87.5% (28/32), pharyngeal mucosal hemorrhage 6.3% (2/32), and hepatomegaly occurred 75% (24/32). In the febrile phase (day of illness 1-3), the mean white blood cell (WBC) counts were 7800 ± 800/mm3 and platelets were 97,111 ± 37,826/mm3. In the critical phase (day of illness 4-6), the mean WBC counts were 13,400 ± 2800/mm3, and platelets were 30,100 ± 5749/mm3. All mothers (100%) had laboratory-confirmed dengue by NS1 positive in the perinatal period. Conclusions The findings emphasize that early diagnosis of neonatal dengue should be based on a history of maternal illness, NS1 rapid test, and clinical presentation such as petechiae, hepatomegaly, and low platelet counts in the febrile phase.

English

BACKGROUND Neonatal thrombocytopenia is one of the most common haematological abnormalities in neonates occurring in 1 to 2 % of healthy term neonates. Various risk factors like sepsis, prematurity, and birth asphyxia are known to be associated with this condition. Maternal factors also predispose to this condition. Early detection and appropriate management is of utmost importance to prevent complications. The aim of the study is to evaluate the predisposing factors for neonatal thrombocytopenia in a teaching hospital. METHODS This was a cross sectional observational study done in the Department of Peadiatrics, MediCiti Institute of Medical Sciences, Medchal, Telangana, for a duration of one year i.e., from January 2019 to December 2019. A total of 60 neonates with thrombocytopenia were studied for onset of thrombocytopenia, severity based on platelet counts, aetiology and for contributing maternal factors. RESULTS Early onset thrombocytopenia (&lt; 3 days of age) was seen in 46.6 % (28 / 60) and late onset thrombocytopenia (3 - 28 days) in 53.3 % (32 / 60). The most common cause for neonatal thrombocytopenia was neonatal sepsis 30 % (10 / 60), followed by birth asphyxia. Common maternal predisposing factors were pregnancyinduced hypertension and pregnancy-induced diabetes mellitus. CONCLUSIONS Neonatal thrombocytopenia is one of the most common clinical problems in neonates. It can be of early or late onset type and has fetal and maternal predisposing factors. Neonatal sepsis is one of the most common cause for neonatal thrombocytopenia followed by birth asphyxia which is a preventable cause. Early diagnosis and thorough evaluation are needed to prevent complications. KEYWORDS Neonatal Thrombocytopenia, Neonatal Sepsis

Maternal Hematologic Conditions and Fetal/Neonatal Outcomes of Pregnancy

Hematologic conditions in reproductive-age women can complicate pregnancy and the neonatal period. Affected pregnancies have a higher risk of severe morbidity and mortality. Coagulation factor changes that occur in the normal state of pregnancy can delay detection and recognition of a bleeding disorder in cases without an apparent bleeding history, thus hindering the appropriate management during gestation and the neonatal period. In addition, unique maternal immunologic changes occur during pregnancy, which are meant to protect the fetus who shares paternal antigens. Rarely, derangement of the maternal immune system may result in alloimmunization against fetal platelet antigens, leading to the development of fetal and/or neonatal thrombocytopenia. Bleeding and platelet disorders pose significant risk of intracranial hemorrhage for the fetus and newborn that is associated with significant morbidity and mortality. We discuss contemporary diagnosis and management of rare bleeding and platelet disorders in pregnancy and their effect on the neonatal period.

Incidence and Risk Factors of Thrombocytopenia in Neonates Admitted With Surgical Disorders to Neonatal Intensive Care Unit of Tikur Anbessa Specialized Hospital; A One-Year Observational Prospective Cohort Study From a Low-Income Country

Background: Thrombocytopenia is one of the most common hematologic disorders affecting neonates who are admitted to the neonatal intensive care unit with a reported incidence of 18-35%. Several maternal, neonatal and perinatal factors contribute to the development of thrombocytopenia. This study is aimed to determine the incidence and associated risk factors of neonatal thrombocytopenia. Methods: An observational prospective cohort study was conducted and all neonates admitted to the neonatal intensive care unit of Tikur Anbessa Specialized Hospital with surgical disorders in the study period were included. Data was collected using a checklist and analysed by SPSS version 23. Chi square test and independent sample T- test were used to asses the association among different variables. Findings: A total of 210 neonates were included in the study out of which 56.2% were males. The incidence of thrombocytopenia in the study period was 55.8%. Among neonates with thrombocytopenia, 90.9% had a late onset thrombocytopenia and half of them were in the severe range (<50,000/µl). The presence of sepsis(P=0.000) and atresia (P=0.000) were found to be significantly associated with the development of thrombocytopenia. The mean non feeding hours were found to be significantly longer for patients with thrombocytopenia (t (199), 5.81, P= 0.000). Interpretation: The incidence of thrombocytopenia in neonates admitted with surgical disorders was high in our institution. Preventive methods towards neonatal sepsis including antenatal and postnatal measures should be given due emphasis. Initiation of oral feedings in neonates as early as feasible is recommended. Funding Statement: Addis Ababa University has granted the fund for this study. Declaration of Interests: None. Ethics Approval Statement: Written informed consent was taken from parents of enrolled neonates and each neonate’s clinical data was kept in confidential manner using a coding system. Ethical clearance for this study was obtained from ethical board of the medical college.

HOW Collaborative position paper on the management of thrombocytopenia in pregnancy

Thrombocytopenia in pregnancy is a common occurrence, affecting up to 10% of women by the time of birth. These recommendations aim to provide pragmatic guidance on the investigation, diagnosis and management of thrombocytopenia in pregnancy; including safety of neuraxial anaesthesia and precautions required for birth. Management of neonatal thrombocytopenia is also addressed. The authors are clinicians representing haematology, obstetric medicine, maternal-fetal medicine, and anaesthesia. Each author conducted a detailed literature review then worked collaboratively to produce a series of unanimous recommendations. The recommendation strength is limited by the lack of high-quality clinical trial data, and represents level C evidence.