Neonatal Platelet Transfusions and Future Areas of Research

Sola‐Visner, Martha; Bercovitz, Rachel S.

doi:10.1016/j.tmrv.2016.05.009

Cited by 40 publications

(33 citation statements)

References 66 publications

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“…A causal link between thrombocytopenia and IVH has not been established, and PT could not reduce the risk of IVH as shown by our data [4]. According to some studies, most preterm neonates who have developed major IVH become thrombocytopenic during the subsequent course of bleeding, as opposed to thrombocytopenia being the cause of IVH [26, 27].…”

Section: Discussionmentioning

confidence: 75%

“…Most studies report an increased risk of bleeding at thrombocyte counts below 20,000/μL [32–34]. Our results show a wide range of thrombocyte counts associated with PT, reflecting uncertainty among clinicians and a lack of data on evidence-based transfusion criteria [4]. …”

Section: Discussionmentioning

confidence: 81%

“…Otherwise, the neonatologist is advised to take into consideration possible risks associated with PT outweighing the severity of associated morbidity. As Sola-Visner and Bercovitz stated, platelet counts frequently drive the decision of whether or not to transfuse, despite the existence of little evidence of what a safe platelet nadir is in both full-term and preterm neonates [4]. According to Baer et al [26], PT should not be given to neonates with a very low risk for IVH (i.e., weight > 1500 g and/or age > 7 days) solely to maintain the platelet count above arbitrary levels; the only indication might be bruising or bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Those born below 28-week gestational age are at especially increased risk for I/PVH. Additionally, a correlation of severity of thrombocytopenia with an increased risk of mortality has been described, and preclinical data suggest that thrombocytopenia contributes to mortality rather than simply being representative of disease severity [4]. Three studies from the USA, the UK, and Mexico reported higher mortality rates in neonates who had received PT compared with those who had not [32, 45, 46].…”

Section: Discussionmentioning

confidence: 99%

“…However, there are few evidence-based guidelines to inform clinicians’ decision-making processes. Developmental differences in hemostasis and differences in underlying disease processes make it difficult to apply PT practices from other patient populations to neonates [4]. Specifically, it is important to identify neonates at risk of bleeding who would benefit from PT and to determine whether PT either abrogate or exacerbate common neonatal complications such as sepsis, chronic lung disease, necrotizing enterocolitis (NEC), and retinopathy of prematurity.…”

Section: Introductionmentioning

confidence: 99%

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Neonatal thrombocytopenia—causes and outcomes following platelet transfusions

et al. 2018

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We evaluated the causes for neonatal thrombocytopenia (NT), the duration of NT, and the indications of platelet transfusions (PT) by means of a retrospective cohort study over a 23-year period. Neonates with NT were identified via ICD-10 code D69.6. Of 371 neonates (1.8/1000 live births) with NT, the majority (312; 84.1%) had early onset thrombocytopenia, and 282 (76%) were preterm born. The most frequent causes for NT were early and late onset sepsis and asphyxia. The mean duration of thrombocytopenia was 10.2 days and was negatively correlated (KK = − 0.35) with the number of PT. PT were given to 78 (21%) neonates, 38 (49%) of whom had very severe NT. The duration of NT was positively related to the severity of NT and the number of subsequent PT. A mortality rate of 10.8% was significantly associated with bleeding signs (p < 0.05) and correlated with increasing number of PT (p < 0.05) but not with the severity of NT (p = 0.4). In the case of relevant hemorrhage, PT did not influence the mortality rate (p = 0.09). All deaths followed neonatal sepsis.Conclusions: Prematurity and diagnoses including early and late onset sepsis and asphyxia were the most common causes of NT. Mortality was not associated with the severity of NT but increased with the number of PT. What is Known: • The causes for neonatal thrombocytopenia (NT) are well known. • The effects of platelet transfusions (PT) and its indications are still a matter of debate and recommendations differ widely. What is New: • The duration of NT is positively related to the severity of NT and the number of subsequent PT. • The mortality rate is not associated with the severity of NT but increases with increasing numbers of PT and in the case of relevant intraventricular hemorrhage (≥ grade II), PT does not influence the mortality rate.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neonatal thrombocytopenia—causes and outcomes following platelet transfusions

et al. 2018

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Platelet Transfusion and Death or Neurodevelopmental Impairment in Children Born Extremely Preterm

Davenport,

Wood,

Heagerty

et al. 2024

JAMA Netw Open

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ImportanceInfants born extremely preterm receive transfusions at higher platelet count thresholds than older children and adults due to concerns for intracranial hemorrhage. A recent randomized trial comparing 2 platelet transfusion thresholds showed the higher threshold was associated with increased risk of long-term adverse neurodevelopmental outcomes.ObjectiveTo evaluate the association of platelet transfusion exposure with death and severe neurodevelopmental impairment (NDI) at 2 years’ corrected age in a cohort of infants born extremely preterm.Design, Setting, and ParticipantsAn observational cohort study and secondary analysis of the Preterm Erythropoietin Neuroprotection Trial, a randomized, placebo-controlled clinical trial of erythropoietin neuroprotection in neonates born extremely preterm, was conducted in 30 neonatal intensive care units in the US from December 1, 2013, to September 31, 2016. This analysis included 819 infants born extremely preterm at 24 to 27 completed weeks of gestation who had a documented outcome (death or neurodevelopmental assessment). Analysis was performed in April 2023.ExposuresAny platelet transfusion during neonatal intensive care unit hospitalization.Main Outcomes and MeasuresThe primary composite outcome was death or severe NDI evaluated at 2 years’ corrected age using the Bayley Scales of Infant Development–Third Edition (BSID-III) and the Gross Motor Function Classification System and was defined as the presence of severe cerebral palsy or a BSID-III composite motor or cognitive score 2 SDs below the mean. Confounding by indication for platelet transfusion was addressed with covariate adjustment and propensity score methods.ResultsOf the 819 infants included in the analysis (429 [52.4%] male; mean [SD] gestational age, 25.5 [1.1] weeks), 245 (30.0%) received at least 1 platelet transfusion during their initial hospitalization. The primary outcome occurred in 46.5% (114 of 245) of infants exposed to a platelet transfusion and 13.9% (80 of 574) of nonexposed infants with a corresponding odds ratio of 2.43 (95% CI, 1.24-4.76), adjusted for propensity score, gestational age at birth, and trial treatment group. The individual components of death and severe NDI were directionally consistent with the overall composite outcome.Conclusions and RelevanceThe findings of this study suggest that platelet transfusion in infants born extremely preterm may be associated with an increased risk of death or severe NDI at 2 years’ corrected age, although the possibility of residual confounding by indication cannot be excluded.

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