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 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.

Ranitidine-induced Thrombocytopenia in a Neonate – A Case Report and Review of Literature

“…Such thrombocytopenia is commonly seen in SGA infants, 1,3,4,12 with even evidence for a (linear) relation between platelet counts and birth weight centile. 4,13 Typically, thrombocytopenia onset in SGA infants is early (<72 hours after birth), only a minority of patients (5%) require platelet transfusion, and no infants are yet reported with a platelet count <20 × 10 9 /L. 13 Additional risk factors for thrombocytopenia were present in our patient, such as maternal diabetes and pre-eclampsia, which causes neonatal platelet depletion in up to 30%.…”

“…4,13 Typically, thrombocytopenia onset in SGA infants is early (<72 hours after birth), only a minority of patients (5%) require platelet transfusion, and no infants are yet reported with a platelet count <20 × 10 9 /L. 13 Additional risk factors for thrombocytopenia were present in our patient, such as maternal diabetes and pre-eclampsia, which causes neonatal platelet depletion in up to 30%. 14 As was expected, the initial platelet depletion in our patient resolved spontaneously, and platelet count was found to be normal at 72 hours of life.…”

Insufficient thrombopoietin due to hepatic dysmature results in thrombocytopenia in small‐for‐gestational‐age rats

“…SGA infants are defined as having a birth weight of less than the 10th percentile of the population‐specific birth weight for a given gestational age 4 . There have been some reports that SGA infants often have transient thrombocytopenia within the first three days of life 5–7 due to low concentrations of serum thrombopoietin (Tpo) 8,9 . However, the detailed mechanism of thrombocytopenia in SGA infants remains unclear.…”

Effect of perinatal factors on platelet indices in late preterm and term newborns

“…Term SGA newborns showed lower PLT and PCT than non-SGA infants, as previously reported. [17][18][19] Reduced platelet count indicates the immaturity of platelet production in SGA newborns. [20] Thrombopoietin, the main regulator of platelet production, is produced by liver.…”