Publication:

Clinical profile and outcome of neonatal thrombocytopenia in a tertiary care neonatal intensive care unit

Background Neonatal thrombocytopenia is a common hematological abnormality in neonatal intensive care units (NICUs), particularly among preterm and low-birth-weight neonates. It is associated with sepsis, respiratory distress syndrome, necrotizing enterocolitis, bleeding manifestations and adverse neonatal outcome. The present study was undertaken to evaluate the clinical profile, associated risk factors, severity, management and short-term outcome of neonatal thrombocytopenia in NICU-admitted neonates.

Methods This hospital-based observational study included 120 neonates with thrombocytopenia admitted to a tertiary care NICU. Neonatal thrombocytopenia was defined as a platelet count <150×10⁹/l and was classified as mild (100–149×10⁹/l), moderate (50–99×10⁹/l) and severe (<50×10⁹/l). It was further categorized as early onset (<72 hours of life) and late onset (≥72 hours). Maternal risk factors, neonatal morbidities, clinical manifestations, treatment details and outcomes were analyzed.

Results Of the 120 neonates, 68 (56.7%) were males and 72 (60.0%) were preterm. Low birth weight was present in 70 (58.3%) neonates and very low birth weight in 24 (20.0%). Mild thrombocytopenia was observed in 58 (48.3%) neonates, moderate in 38 (31.7%) and severe in 24 (20.0%). Early-onset thrombocytopenia was noted in 62 (51.7%) cases. Sepsis was the commonest associated condition, seen in 59 (49.2%) neonates, followed by respiratory distress syndrome in 34 (28.3%), perinatal asphyxia in 21 (17.5%) and necrotizing enterocolitis in 20 (16.7%). Platelet transfusion was required in 26 (21.7%) neonates. Mortality increased with severity, from 3/58 (5.2%) in mild thrombocytopenia to 8/24 (33.3%) in severe thrombocytopenia.

Conclusions Neonatal thrombocytopenia is strongly associated with prematurity, low birth weight, sepsis and necrotizing enterocolitis. Increasing severity is associated with worse clinical outcome and higher mortality.