Risk Of Neonatal Thrombocytopenia Research Articles

Trombocitopenija kao jedan od razloga produžene hospitalizacije na Odeljenju neonatalne intenzivne nege

The aim of this paper was to present the occurrence and severity of thrombocytopenia, with intracranial and another bleeding in neonates with sepsis, analyze the risk factors for the development of thrombocytopenia and compare it with the length of hospitalization in the Neonatal Intensive Care Unit (NICU). Thrombocytopenia is a platelet count <150 x 109/L and is common in newborns during hospitalization in the NICU. In the early days of life, the most common causes of thrombocytopenia in newborns are conditions that lead to fetal hypoxia, intrauterine growth failure, maternal hypertension, and sepsis. In this study were included all newborns with thrombocytopenia, who were hospitalized in NICU, Children's Disease Clinic, University Clinical Centre in Tuzla, from 01. 01. 2014 to 01. 01. 2019. In our results, 379 newborns had severe, 337 moderate, and 127 milder forms of thrombocytopenia, without a statistically significant difference in the incidence of thrombocytopenia between groups of neonates born < 37 GW and 37 GW. Sepsis was the most common cause of thrombocytopenia, 300 children had early sepsis and 190 late. We found the statistically significant difference in intracranial hemorrhage of the second degree and pulmonary hemorrhage among neonates born < 37 GW in relation to newborns born 37 GW. A statistically significant effect of length of stay of our neonates in the Department of Neonatal Intensive Therapy and morbidity was shown in relation to the lower gestational age and lower platelet counts. Conclusion: Timely diagnosis of the cause and development of thrombocytopenia with adequate and effective treatment can reduce the mortality and morbidity of newborns with perinatal risk for neonatal thrombocytopenia.

821: Clinical characteristics, neonatal risk and recurrence rate of gestational thrombocytopenia with platelet count

Gestational thrombocytopenia (GT) accounts for 75% of cases of thrombocytopenia in pregnancy. In most cases of GT, thrombocytopenia is mild (100-150 X 109/L) and has no consequences for either the mother or the fetus. We aimed to investigate the characteristics, neonatal risk and recurrence rate of GT with a platelet count <100 X 109/L. We reviewed the records of women who delivered during 2006-2016 at a large tertiary care university hospital, and who had platelet count <100 X 109/L during pregnancy. Of 97 pregnancies in which platelet count lower than 100 X 109/L was encountered, 66 (68%) were diagnosed as GT and 31 (32%) as new-onset immune-thrombocytopenic purpura (ITP). The proportions of women with onset of thrombocytopenia in early pregnancy (P=0.004) and a lower maternal nadir platelet count (P=0.01) were higher among those with new-onset ITP than GT. Neonatal thrombocytopenia (<100 X 109/L) was encountered following comparable proportions of pregnancies of women with new-onset ITP and GT (16.1% vs. 10.6%, P=0.51). Among women with GT, the rate of neonatal thrombocytopenia was higher in those who experienced antepartum bleeding (P=0.009) and in whom the onset of thrombocytopenia was in early pregnancy (P=0.002). Of 40 subsequent pregnancies, a recurrence of GT (<100 X 109/L) was encountered in 22 (55%), with similar maternal and perinatal outcomes compared to the initial pregnancy. The risk of neonatal thrombocytopenia was substantial and similar in GT and new-onset ITP. The recurrence rate of GT was high in subsequent pregnancies.

Can we predict neonatal thrombocytopenia in offspring of women with idiopathic thrombocytopenic purpura?

BackgroundWe aimed to investigate which factors in the clinical profile of mothers with idiopathic thrombocytopenic purpura (ITP) can predict neonatal risk of thrombocytopenia.MethodsData was retrospectively collected from all pregnant women with ITP who presented to our institution between 2001 and 2013. Neonatal offspring of these women were classified into 2 groups based on the presence or absence of neonatal thrombocytopenia (platelet count <100×109/L). Several parameters were compared between the 2 groups, including maternal age, maternal platelet count, maternal treatment history, and thrombocytopenia in siblings. We further examined the correlation between maternal platelet count at the time of delivery and neonatal platelet count at birth; we also examined the correlation between the minimum platelet counts of other children born to multiparous women.ResultsSixty-six neonates from 49 mothers were enrolled in the study. Thrombocytopenia was observed in 13 (19.7%) neonates. Maternal treatment for ITP such as splenectomy did not correlate with a risk of neonatal thrombocytopenia. Sibling thrombocytopenia was more frequently observed in neonates with thrombocytopenia than in those without (7/13 vs. 4/53, P<0.01). No association was observed between maternal and neonatal platelet counts. However, the nadir neonatal platelet counts of first- and second-born siblings were highly correlated (r=0.87).ConclusionThrombocytopenia in neonates of women with ITP cannot be predicted by maternal treatment history or platelet count. However, the presence of an older sibling with neonatal thrombocytopenia is a reliable risk factor for neonatal thrombocytopenia in subsequent pregnancies.

The neonate at risk for thrombocytopenia

Thrombocytopenia is one of the commonest haematological problems of neonates. The incidence varies greatly depending on the patient population, and the pathogenesis involves various immune and nonimmune mechanisms. Before birth, the risk of neonatal thrombocytopenia can be assessed by considering the maternal history, pregnancy complications, and family history. In non-thrombocytopenic neonates the risk that thrombocytopenia might subsequently develop during the hospital course can be assessed. In some cases this risk assessment allows prediction of the timing of presentation; early or late-onset. Early-onset (congenital) thrombocytopenia can be the kinetic result of either reduced platelet production or accelerated platelet consumption. In late-onset neonatal thrombocytopenia the principal kinetic mechanism is generally accelerated platelet consumption.

Linking Maternal Platelet Counts with Neonatal Platelet Counts and Outcomes Using the Data Repositories of a Multihospital Health Care System

It is unclear whether neonates born to women with thrombocytopenia during pregnancy are themselves at increased risk for thrombocytopenia at birth. In the current retrospective study, platelet count reference ranges were developed for pregnant women according to trimester, and correlations were sought between the platelet counts of mothers at delivery and their neonates. During the study period, 92,518 platelet counts were recorded on 41,887 pregnant women. A progressive shift toward lower platelet counts in a similarly shaped histogram occurred during pregnancy, with the lower reference range (2.5 percentile) for platelets during the third trimester being 113 × 10(9)/L. Among 11,797 maternal-neonatal pairs following delivery, no correlation was observed between maternal and neonatal counts. However, if the mother's lowest count was <50 × 10(9)/L, the relative risk of any degree of thrombocytopenia in their neonate was 4.6 (95% confidence interval [CI], 1.8 to 33.3) and the relative risk of severe neonatal thrombocytopenia was 7.8 (95% CI, 1.8 to 33.3). The results of the current study demonstrate that platelet counts >75 × 10(9)/L in pregnant women were not associated with an increased risk of neonatal thrombocytopenia, and maternal platelet counts of <50 × 10(9)/L were accompanied by an almost fivefold risk increase of neonatal thrombocytopenia.

Absent umbilical artery end-diastolic velocity in growth-restricted fetuses: a risk factor for neonatal thrombocytopenia

Objective: To examine the relationship between umbilical artery (UA) end-diastolic flow and neonatal thrombocytopenia. Methods: We prospectively examined 115 anatomically normal single fetuses with UA pulsatility indices more than two standard deviations above the gestational age mean and subsequent birth weights below the tenth percentile. Peripheral neonatal platelet counts in fetuses with positive UA end-diastolic velocity were compared with those of fetuses with absent or reversed UA end-diastolic velocity. Results: Sixty-seven fetuses (58.3%) had positive UA end-diastolic velocity and 48 (41.7%) had absent or reversed UA end-diastolic velocity. Three neonates in the positive-flow group and 22 neonates in the absent- or reversed-flow group had platelet counts of less than 100,000/mm 3 (relative risk 10.2; 95% confidence interval; 3.2, 32.3; P < .001). Absent or reversed end-diastolic velocity had a sensitivity of 88%, specificity of 71%, positive predictive value of 46%, and negative predictive value of 96% for predicting neonatal thrombocytopenia. Neonates with absent or reversed flow also had lower median platelet counts (101,500/mm 3 versus 208,000/mm 3, P < .001), hemoglobin levels (15.1 versus 16.4 g/dL, P < .01), and hematocrits (47.6 versus 51.1%, P < .05), as well as higher nucleated red blood cell counts (191 versus 15 per 100 white blood cells, P < .001). Conclusion: Absent or reversed UA end-diastolic velocity in growth-restricted fetuses is associated with a statistically significant increase in risk of neonatal thrombocytopenia.

Maternal Antiplatelet Antibodies in Predicting Risk of Neonatal Thrombocytopenia

Maternal Antiplatelet Antibodies in Predicting Risk of Neonatal Thrombocytopenia

Pregnancy-Associated Thrombocytopenia Revisited: Assessment and Follow-Up of 50 Cases

AbstractThrombocytopenia detected during pregnancy addresses the issue of its mechanism and of the possible occurrence of neonatal thrombocytopenia. To further investigate these issues, 50 women referred to us because of thrombocytopenia detected during pregnancy (platelet count, <150 × 109/L), were extensively studied, as well as their offspring. Among these thrombocytopenic women, we used the threshold of 70 × 109/L to differentiate between mild and severe thrombocytopenia. Whatever the severity of thrombocytopenia, we found biological features of an autoimmune disorder in 48% of the women, and chronic thrombocytopenia in 55%. A familial thrombocytopenia was evidenced in 1 case. These 50 women gave birth to 63 neonates, among whom 24 were thrombocytopenic, either at birth or during the first week of life. Neonatal thrombocytopenia could only be predicted in multiparous women, on the basis of previous neonatal thrombocytopenia in older siblings, and/or when maternal platelet life span study, performed before pregnancy, had evidenced an autoimmune thrombocytopenia (AITP)-like profile. These results suggest that, in case of pregnancy-associated thrombocytopenia, familial and immunological studies, combined with postdelivery iterative platelet counts, should be performed to properly characterize the thrombocytopenia. Moreover, the platelet count of the neonate should be carefully assessed at birth and during the following days, a platelet life span study should be performed after delivery in the mother, because these two parameters are likely to bring valuable information regarding the forthcoming pregnancies and the risk of neonatal thrombocytopenia.

Pregnancy-Associated Thrombocytopenia Revisited: Assessment and Follow-Up of 50 Cases

Thrombocytopenia detected during pregnancy addresses the issue of its mechanism and of the possible occurrence of neonatal thrombocytopenia. To further investigate these issues, 50 women referred to us because of thrombocytopenia detected during pregnancy (platelet count, &lt;150 × 109/L), were extensively studied, as well as their offspring. Among these thrombocytopenic women, we used the threshold of 70 × 109/L to differentiate between mild and severe thrombocytopenia. Whatever the severity of thrombocytopenia, we found biological features of an autoimmune disorder in 48% of the women, and chronic thrombocytopenia in 55%. A familial thrombocytopenia was evidenced in 1 case. These 50 women gave birth to 63 neonates, among whom 24 were thrombocytopenic, either at birth or during the first week of life. Neonatal thrombocytopenia could only be predicted in multiparous women, on the basis of previous neonatal thrombocytopenia in older siblings, and/or when maternal platelet life span study, performed before pregnancy, had evidenced an autoimmune thrombocytopenia (AITP)-like profile. These results suggest that, in case of pregnancy-associated thrombocytopenia, familial and immunological studies, combined with postdelivery iterative platelet counts, should be performed to properly characterize the thrombocytopenia. Moreover, the platelet count of the neonate should be carefully assessed at birth and during the following days, a platelet life span study should be performed after delivery in the mother, because these two parameters are likely to bring valuable information regarding the forthcoming pregnancies and the risk of neonatal thrombocytopenia.