Prospective, observational study of outcomes in neonates with severe thrombocytopenia.
OBJECTIVE
A cross-sectional, observational study of outcomes for neonates with severe neonatal thrombocytopenia (SNT; platelet count of <60 x 10(9) platelets per L) was performed to examine hemorrhage and use of platelet transfusions.


METHODS
Neonates who were admitted to 7 NICUs and developed SNT were enrolled for daily data collection.


RESULTS
Among 3652 neonatal admissions, 194 neonates (5%) developed SNT. The median gestational age of 169 enrolled neonates was 27 weeks (interquartile range [IQR]: 24-32 weeks), and the median birth weight was 822 g (IQR: 670-1300 g). Platelet count nadirs were <20 x 10(9), 20 to 39 x 10(9), and 40 to 59 x 10(9) platelets per L for 58 (34%), 64 (39%), and 47 (28%) of all enrolled infants, respectively. During the study, 31 infants (18%) had no recorded hemorrhage, 123 (73%) developed minor hemorrhage, and 15 (9%) developed major hemorrhage. Thirteen (87%) of 15 episodes of major hemorrhage occurred in neonates with gestational ages of <28 weeks. Platelet transfusions (n = 415) were administered to 116 infants (69%); for 338 (81%) transfusions, the main recorded reason was low platelet count. Transfusions increased the platelet count from a median of 27 x 10(9) platelets per L (IQR: 19-36 x 10(9) platelets per L) to 79 x 10(9) platelets per L (IQR: 47.5-127 x 10(9) platelets per L).


CONCLUSIONS
Although one third of neonates enrolled in this study developed thrombocytopenia of <20 x 10(9) platelets per L, 91% did not develop major hemorrhage. Most platelet transfusions were given to neonates with thrombocytopenia with no bleeding or minor bleeding only.
National Blood Service, Level 2, John Radcliffe Hospital, Headington, Oxford OX3 9BQ, England. simon.stanworth@nbs.nhs.uk
Simon J
SJ
Stanworth
Paul
P
Clarke
Tim
T
Watts
Sally
S
Ballard
Louise
L
Choo
Tim
T
Morris
Mike F
MF
Murphy
Irene
I
Roberts
D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood / Q000401:mortality / Q000628:therapy*; D020300:Intracranial Hemorrhages / Q000209:etiology; D010976:Platelet Count; D017713:Platelet Transfusion; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000097:blood / Q000401:mortality / Q000628:therapy*