title: Severe thrombocytopenia predicts outcome in neonates with necrotizing enterocolitis.
abstract: OBJECTIVE
  Necrotizing enterocolitis (NEC) is a common and serious gastrointestinal disorder that predominately affects premature infants. Few prognostic indices are available to guide physicians through the expected course of the disease. We hypothesized that the degree and timing of onset of severe thrombocytopenia (platelet count <100,000/mm(3)) would be a predictor of adverse outcome and an indication for surgical intervention in infants with NEC.
  
  
  METHODS
  The clinical presentation and outcome of all infants with Bell stage II or III NEC treated at Texas Children's Hospital between 1997 and 2001 were retrospectively reviewed. Patients were stratified into two groups based on the presence (Group1) or absence (Group 2) of severe thrombocytopenia (platelet count <100,000/mm(3)) within 3 days of a diagnosis of NEC. Differences between groups were compared using logistic regression to estimate adjusted odds ratios.
  
  
  RESULTS
  A total of 91 infants met inclusion criteria (average birth weight 1288+/-135 g; average gestational age 29.0+/-3.0 weeks). Compared to infants in Group 2, infants in Group 1 were more premature (28.0+/-4.1 vs 30.0+/-4.2 weeks; p=0.02), more likely to have received postnatal steroids (42.5% vs 20.4%; p=0.02), and more likely to require laparotomy for gangrenous bowel (adjusted OR 16.33; p<0. 001). The presence of severe thrombocytopenia was also a predictor of mortality (adjusted OR 6.39; p=0.002) and NEC-related gastrointestinal complications including cholestatic liver disease and short bowel syndrome (adjusted OR 5.47; p=0.006).
  
  
  CONCLUSIONS
  Severe thrombocytopenia within the first 3 days after a diagnosis of NEC suggests a higher likelihood of bowel gangrene, morbidity, and mortality. Prospective studies of infants with early and severe thrombocytopenia may help determine the optimal timing of laparotomy in infants with NEC.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Kenton
authors.forename: Donough
authors.initials: D
authors.lastname: O'Donovan
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
authors.forename: Michael A
authors.initials: MA
authors.lastname: Helmrath
authors.forename: E O'brian
authors.initials: EO
authors.lastname: Smith
authors.forename: Caraciolo J
authors.initials: CJ
authors.lastname: Fernandes
authors.forename: Kimberly
authors.initials: K
authors.lastname: Washburn
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Weihe
authors.forename: Mary L
authors.initials: ML
authors.lastname: Brandt
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000097:blood* / Q000150:complications* / Q000601:surgery; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007813:Laparotomy; D010976:Platelet Count; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome