Platelet Transfusions in Infants with Necrotizing Enterocolitis Do Not Lower Mortality but May Increase Morbidity

Kenton, Alexander B.; Hegemier, Suzanne; Smith, E. O’Brian; O'Donovan, Donough J; Brandt, Mary L.; Cass, Darrell L.; Helmrath, Michael A.; Washburn, Kimberly K.; Weihe, Elizabeth; Fernandes, Caraciolo J.

doi:10.1038/sj.jp.7211237

Cited by 77 publications

(53 citation statements)

References 34 publications

(51 reference statements)

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“…We speculate that the lack of immune-mediated cases could be the result of inadequate testing in this population. Similarly, infection with bacteria, viruses, or fungi can cause thrombocytopenia, [16][17][18][19][20][21] and we speculate that such infections may have been responsible for more cases that were documented. DIC can result in thrombocytopenia, 20 and we found this diagnosed in 40 of the 208 cases.…”

Section: Discussionmentioning

confidence: 77%

Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system

Henry²,

et al. 2006

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Objectives: Thrombocytopenia is common in neonatal intensive care units (NICU), with 18 to 35% of patients developing this problem before hospital discharge. It might be even more common among extremely low birth weight neonates (ELBW, p1000 g birth weight). However, little is known about thrombocytopenia in the ELBW population. We sought to determine the incidence, timing, causes, platelet transfusions given, and outcomes of thrombocytopenia among ELBW neonates. Results: Multiple platelet counts were obtained in all 284 (range, 4 to 441 platelet counts/patient). Of the 284, 208 (73%) had one or more platelet counts p150 000/ml. Most were detected during the first days of life; 80% were detected during the first week and only 20% were detected thereafter. Thrombcytopenia was more common among the smallest patients; 85% incidence among those p800 g, 60% among those 801 to 900 g, and 53% among those 901 to 1000 g. Platelet transfusions were given to 129 of the 208 thrombocytopenic neonates. More than 90% were given prophylactically (the patient was not bleeding). The mortality rate among those that received platelet transfusions was twice that of those that received no platelet transfusions (P<0.01). In 48% of cases, the cause of the thrombocytopenia went undiagnosed. The most common explanations were being small for gestational age or delivered to a hypertensive mother, DIC, bacterial infection, fungal infection, and necrotizing enterocolitis, respectively. Conclusions:We observed thrombocytopenia among ELBW neonates at a rate more than twice that reported among the general NICU population. Much remains to be discovered about the etiology and best treatments of thrombocytopenia among ELBW neonates.

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Section: Discussionmentioning

confidence: 77%

Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system

Henry²,

et al. 2006

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“…The association between more platelet transfusions and higher mortality rates has been ascribed to the fact that ill neonates are more likely to receive multiple platelet transfusions. [4][5][6][7]11 It has been presumed platelet transfusions are not a cause of mortality, but rather, are a co-morbid marker. 1,2 However, there are many theoretical reasons why multiple platelet transfusions themselves could be harmful in this population of patients.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12] The great majority of platelet transfusions in the NICU, over 98% in some series, are given prophylactically to non-bleeding neonates who have a low platelet count, with the intention of preventing hemorrhage. 1,2,4,5,11 However, despite their common usage, neither the benefits nor the risks of prophylactic platelet transfusions have been well defined in this patient population.…”

Section: Introductionmentioning

confidence: 99%

“…Another risk of platelet transfusions relates to the concentrations of various bioactive factors, including platelet-activating factor, which might lead to or exacerbate inflammatory injury. 5,11 While prophylactic platelet transfusions are given to prevent bleeding, Kahn et al 9 reported that neonates receiving multiple platelet transfusions actually had a higher incidence of intraventricular hemorrhage. We found a similar trend in our data with grades 3 and 4 intraventricular hemorrhage of 4% in those receiving no platelet transfusions, vs 20% in those that received >10 transfusions.…”

mentioning

confidence: 99%

“…2,5,10,[17][18][19] The most common complication of platelet transfusion is bacterial infection. 10,11,17 Due to the nature of their preparative and storage processes, such as the need to store platelet concentrates at room temperature, platelet products have a much higher risk of bacterial contamination than do erythrocytes or plasma products. Perhaps, up to 10% of platelet preparations are contaminated with small concentrations of bacteria.…”

mentioning

confidence: 99%

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Do platelet transfusions in the NICU adversely affect survival? Analysis of 1600 thrombocytopenic neonates in a multihospital healthcare system

Baer

Lambert

Henry³

et al. 2007

J Perinatol

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Objective: Several studies have indicated a correlation between the number of platelet transfusions received by newborn intensive care unit (NICU) patients and the mortality rate. The number of platelet transfusions might be a marker for level of illness, and thus predictive of mortality. However, an alternative hypothesis is that multiple platelet transfusions themselves are harmful in this population.Study Design: We evaluated data from all thrombocytopenic neonates cared for in the Intermountain Healthcare NICUs in the past 4 years, seeking associations between the lowest platelet count recorded, number of platelet transfusions received and mortality rate. We also conducted a sensitivity analysis to examine the hypothesis that platelet transfusions were responsible for some fraction of the mortality rate.Result: Transfusion and outcome data were examined from 1600 thrombocytopenic NICU patients. At any level of platelet count, some patients received platelet transfusions but others did not. However, at all levels of platelet count, those that received platelet transfusions had a higher mortality rate. Neonates not given any platelet transfusions had a mortality rate of 2%, those with 1 or 2 transfusions had a mortality rate of 11% (P<0.001); those with >10 had a mortality rate of 35% (P<0.001); and those with X20 had a mortality rate of 50% (P<0.001). A sensitivity analysis suggested that the platelet transfusions themselves were very likely responsible for some fraction of the increasing mortality rate. Conclusion:The number of platelet transfusions administered in the NICU predicts the mortality rate. Some of this correlation is ascribable to unknown and unmeasured factors such as level of illness. However, the present data and the sensitivity analysis both suggest that some of this correlation is due to harmful effects of multiple platelet transfusions in this group of patients.

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Platelet transfusion thresholds for thrombocytopenic infants

Chotas,

Wallman-Stokes,

Patel

et al. 2024

Cochrane Database of Systematic Reviews

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Platelet Transfusions in Infants with Necrotizing Enterocolitis Do Not Lower Mortality but May Increase Morbidity

Abstract: This retrospective analysis suggests that greater number and volume of platelet transfusions in infants with necrotizing enterocolitis are associated with greater morbidity in the form of short bowel syndrome and/or cholestasis without the benefit of lower mortality.

Cited by 77 publications

References 34 publications

Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system

Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system

Do platelet transfusions in the NICU adversely affect survival? Analysis of 1600 thrombocytopenic neonates in a multihospital healthcare system

Platelet transfusion thresholds for thrombocytopenic infants

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