Incidence of thrombocytopenia in neonates receiving phototherapy for indirect hyperbilirubinemia: a prospective cohort study

Abstract

Background: Thrombocytopenia as a side effect of phototherapy has not been mentioned in the standard literature but was described briefly as isolated case reports after the phototherapy came in vogue in 1958. The purpose of this study was to find the incidence of thrombocytopenia in neonates with uncomplicated indirect hyperbilirubinemia receiving phototherapy in a referral hospital.Methods: This was a prospective cohort study conducted in a referral hospital over a period of 18 months from June 1, 2013 to November 1, 2014.Results: A total of 103 babies were enrolled. The overall incidence of post-phototherapy thrombocytopenia was 45.6% while mild, moderate and severe thrombocytopenia was present in 66%, 21.3% and 12.8% of babies respectively. The lowest platelet count observed was 31,000/mm3 but none of the neonates showed bleeding manifestations. The incidence of thrombocytopenia following phototherapy was significantly higher in preterm babies, infants who received double surface phototherapy, babies who received phototherapy for >72 hours and in babies who received phototherapy on day 2 or 3 of life.Conclusions: Neonates requiring phototherapy for hyperbilirubinemia are at risk of developing thrombocytopenia, hence the treatment should be initiated based on the standard guidelines. Unnecessary use and prolongation of phototherapy should be avoided considering the possible side effects. Platelet count should be monitored particularly in pre-term neonates receiving phototherapy. Neonates receiving double surface phototherapy and those requiring phototherapy for longer duration require more frequent platelet count monitoring.

Impact of Phototherapy on Platelet Count in Neonates With Indirect Hyperbilirubinemia

“…In our study, the neonatal age with starting phototherapy ranged between 2 and 8 days, the incidence of thrombocytopenia was higher with starting the phototherapy within 72 hours of birth than beyond that, but it was not statistically significant p=0.780. This came in agreement with the study conducted by Shah et al, 2019 (6) that revealed that the incidence of thrombocytopenia was higher with starting the phototherapy within 72 hours of birth than beyond ; however, it was statistically significant (p<0.05) .…”

“…The incidence of thrombocytopenia was higher in neonates receiving DSPT as compared to those who received SSPT, but there was no statistically significant difference in the incidence of thrombocytopenia based on type of phototherapy p(=1.000) which was In agreement with the study conducted by Shah et al, 2019 (6) and Khera and Gupta, 2011 (5) which revealed that the incidence of thrombocytopenia was higher in neonates receiving double surface Phototherapy (DSPT), however it was not statistically significant (p>0.05) and (p=0.45 )respectively.…”

“…The incidence of thrombocytopenia was higher in low birth weight neonates than those with appropriate weight for age which was statistically significant (p=<0.0001).this came in agreement with the study performed by Shah et al, 2019 (6) that revealed that The incidence of thrombocytopenia was higher in low birth weight neonates than those with appropriate weight for age but it was not statistically significant (p>0.05). In disagreement with our study, the study done by Khera and Gupta, 2011 (5) that reported that the incidence of thrombocytopenia was higher in neonates weighing >2.5 Kg (p=0.11).…”

“…. DISCUSSION Thrombocytopenia as a side effect following exposure to phototherapy was documented by our study.The overall incidence of thrombocytopenia was 7.5% .this came in agreement with Khera and Gupta, 2011 (5) and Shah et al, 2019 (6) who showed that phototherapy was complicated by thrombocytopenia in 35% and 45.6% of neonates who received phototherapy.In disagreement with our study, the study done by Monsef et al ., 2011 (7) which reported that there was an increase in the platelet count after phototherapy As regarding to severity of thrombocytopenia, our study showed that 3 neonates (33.3%), 4 neonates (44.4%) and 2 neonates (22.2 %) of neonates who developed thrombocytopenia had mild, moderate and severe thrombocytopenia respectively. In disagreement with our study, the study of Khera and Gupta, 2011 (5) showed that majority of neonates had mild thrombocytopenia (74%), moderate and severe thrombocytopenia was seen in 23% and 3% cases respectively.…”

The effect of solarium light therapy on selected biological and biochemical parameters of peripheral blood in young and old horses

“…Moreover, Yang et al [52] demonstrated that low-level light therapy is effective in the treatment of immune thrombocytopenia because it increases total PLT counts. In contrast, Khera and Gupta [53] and Shah et al [54] reported that phototherapy decreased PLT counts. In the present study we observed steady increase of PLT, however gradual and non-significant.…”