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.
Stanworth
Simon J
SJ
National Blood Service, Level 2, John Radcliffe Hospital, Headington, Oxford OX3 9BQ, England. simon.stanworth@nbs.nhs.uk
Clarke
Paul
P
Watts
Tim
T
Ballard
Sally
S
Choo
Louise
L
Morris
Tim
T
Murphy
Mike F
MF
Roberts
Irene
I
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*