title: Early-Onset Thrombocytopenia in Small-For-Gestational-Age Neonates: A Retrospective Cohort Study.
abstract: Thrombocytopenia is a common finding in small for gestational age (SGA) neonates and is thought to result from a unique pathophysiologic mechanism related to chronic intrauterine hypoxia. Our objective was to estimate the incidence and severity of early-onset thrombocytopenia in SGA neonates, and to identify risk factors for thrombocytopenia. We performed a retrospective cohort study of all consecutive SGA neonates admitted to our ward and a control group of appropriate for gestational age (AGA) neonates matched for gestational age at birth. Main outcome measures were incidence and severity of thrombocytopenia, hematological and clinical risk factors for thrombocytopenia, and bleeding. A total of 330 SGA and 330 AGA neonates were included, with a mean gestational age at birth of 32.9 ± 4 weeks. Thrombocytopenia (<150x10(9)/L) was found in 53% (176/329) of SGA neonates and 20% (66/330) of AGA neonates (relative risk (RR) 2.7, 95% confidence interval (CI) [2.1, 3.4]). Severe thrombocytopenia (21-50x10(9)/L) occurred in 25 neonates (8%) in the SGA and 2 neonates (1%) in the AGA group (RR 12.5, 95% CI [3.0, 52.5]). Platelet counts <20x10(9)/L were not recorded. Within the SGA group, lower gestational age at birth (p = <0.01) and erythroblastosis (p<0.01) were independently associated with a decrease in platelet count. Platelet count was positively correlated with birth weight centiles. In conclusion, early-onset thrombocytopenia is present in over 50% of SGA neonates and occurs 2.7 times as often as in AGA neonates. Thrombocytopenia is seldom severe and is independently associated with lower gestational age at birth and erythroblastosis.
authors.affiliation: Sanquin Blood Supply, Clinical Transfusion Research, Leiden, Zuid-Holland, The Netherlands.|Academic Medical Center, Pediatric hematology, Amsterdam, Noord-Holland, The Netherlands.
authors.forename: S F
authors.identifier: 0000-0002-1607-2581
authors.initials: SF
authors.lastname: Fustolo-Gunnink
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: R D
authors.initials: RD
authors.lastname: Vlug
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: V E H J
authors.initials: VE
authors.lastname: Smits-Wintjens
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Heckman
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: A B
authors.initials: AB
authors.lastname: Te Pas
authors.affiliation: Academic Medical Center, Pediatric hematology, Amsterdam, Noord-Holland, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Fijnvandraat
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Lopriore
mesh_terms: D017668:Age of Onset; D001724:Birth Weight; D004912:Erythrocytes / Q000378:metabolism; D005260:Female; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age / Q000097:blood*; D008297:Male; D010976:Platelet Count; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000097:blood / Q000150:complications / Q000453:epidemiology*