title: Is thrombocytopenia suggestive of organism-specific response in neonatal sepsis?
abstract: BACKGROUND
  It is controversial whether thrombocytopenia is suggestive of one (or more) causative agents of neonatal sepsis: a low platelet count has been related in turn to Gram-positive, Gram-negative or fungal sepsis.
  
  
  METHODS
  A retrospective, cohort study on 514 very low-birthweight (VLBW) neonates admitted over a 9 year period to a large tertiary neonatal intensive care unit (NICU) in Italy was carried out. Through database search, data on platelet counts, sepsis, clinical course, and microbiological culture were collected and analyzed. Statistical analysis was performed to look for significant association between thrombocytopenia and sepsis caused by different (Gram-positive, Gram-negative or fungal) organisms.
  
  
  RESULTS
  Sepsis diagnosed on microbiological criteria occurred in 197 of 514 VLBW neonates (38.3%), and thrombocytopenia (at least one finding of platelet count <80,000/mm(3)) was detected in 34 (17.2%) of the 197 septic infants. Thrombocytopenia occurred in 10 of 51 neonates with fungal sepsis (19.6%), and in 24 of 146 with bacterial sepsis (16.4%; P = 0.37). The difference was not significant when clustering for sepsis caused by Gram-positive (nine thrombocytopenic of 51 with Gram-positive sepsis, 17.6%; P = 0.40) and Gram-negative organisms (15/95, 15.7%; P = 0.22), or when considering only coagulase-negative Staphylococcus sepsis (6/37, 16.2%; P = 0.25).
  
  
  CONCLUSIONS
  In contrast with previous reports, thrombocytopenia might not be an organism-specific marker of sepsis. Caution should be maintained in relating a low platelet count to any infectious agent (or group of agents) in preterm VLBW neonates.
authors.affiliation: Neonatology and Hospital Neonatal Intensive Care Unit, Sant'Anna Hospital, University of Torino, Torino, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Manzoni
authors.forename: Michael
authors.initials: M
authors.lastname: Mostert
authors.forename: Paolo
authors.initials: P
authors.lastname: Galletto
authors.forename: Luca
authors.initials: L
authors.lastname: Gastaldo
authors.forename: Elena
authors.initials: E
authors.lastname: Gallo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Agriesti
authors.forename: Daniele
authors.initials: D
authors.lastname: Farina
mesh_terms: D002177:Candidiasis / Q000097:blood / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000097:blood* / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000097:blood* / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D010976:Platelet Count; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000453:epidemiology / Q000382:microbiology*; D013921:Thrombocytopenia / Q000453:epidemiology / Q000382:microbiology*