Prospective, Observational Study of Outcomes in Neonates With Severe Thrombocytopenia

Stanworth, Simon; Clarke, Paul; Watts, Troy; Ballard, S.; Choo, Louise; Morris, Tim P.; Murphy, Mike; Roberts, Irene

doi:10.1542/peds.2009-0332

Cited by 156 publications

(162 citation statements)

References 30 publications

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“…Thrombocytopenia is a common problem among patients in neonatal intensive care units [1,2,5,6,[14][15][16][17][18]. The majority of these are acquired varieties of consumptive thrombocytopenia accompanying bacterial or fungal sepsis or necrotizing enterocolitis [1,2,5,6].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of these are acquired varieties of consumptive thrombocytopenia accompanying bacterial or fungal sepsis or necrotizing enterocolitis [1,2,5,6]. Rare varieties of hyoregenerative thrombocytopenia accompany aneuploidy or syndromes involving thrombopoietic failure [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

“…Elevated NRBCs at birth were common in the thrombocytopenic neonates, thus they postulated, as had Meberg et al, that the condition was due to reduced platelet production associated with chronic intrauterine hypoxia. Our present study used a large multihospital data set to better define this condition, which has come to be termed the "thrombocytopenia of SGA" [1][2][3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…Neonates who are born small for gestational age (SGA; <10 th % birth weight for a reference population) are at risk of having thrombocytopenia in the first weeks after birth [1][2][3][4][5][6]. Some such neonates have varieties of thrombocytopenia that are readily recognized, such as the consumptive thrombocytopenias accompanying DIC, ECMO, or early-onset sepsis, or the hyporegenerative thrombocytopenias associated with marrow-failure syndromes.…”

Section: Introductionmentioning

confidence: 99%

“…Some such neonates have varieties of thrombocytopenia that are readily recognized, such as the consumptive thrombocytopenias accompanying DIC, ECMO, or early-onset sepsis, or the hyporegenerative thrombocytopenias associated with marrow-failure syndromes. Other SGA neonates have a type of thrombocytopenia with no obvious explanation; a variety sometimes termed by exclusion "the thrombocytopenia of SGA" [1][2][3][4][5][6]. That variety has been the subject of previous reports, but many aspects remain unclear.…”

Section: Introductionmentioning

confidence: 99%

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Thrombocytopenia in Small-for-Gestational-Age Infants

2015

PEDIATRICS

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Thrombocytopenia in Small-for-Gestational-Age Infants

2015

PEDIATRICS

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Association of Bleeding Scores and Platelet Transfusions With Platelet Counts and Closure Times in Response to Adenosine Diphosphate (CT-ADPs) Among Preterm Neonates With Thrombocytopenia

et al. 2020

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A total of 17 patients (31.5%) received 21 PTX at a mean (SD) PC of 49 (21) × 10 3 /μL. They exhibited significant 1-day increases in PC (mean [SD] change, 31 [9]; P = .002) and decreases in CT-ADP (mean [SE] change, −51 [22]; P = .03) but no significant changes in BS. Fresh frozen plasma (9 transfusions given to 8 infants [14.8%]) or erythrocyte transfusions were not associated with CT-ADP or BS changes (Table ). DiscussionThe main finding of this study was an association between changes in BS and changes in CT-ADP (but not PC), suggesting that primary hemostasis and bleeding are dynamic and more interconnected than PC and bleeding in extremely preterm neonates with thrombocytopenia. Limitations of our study included the small number of infants with PCs less than 50 × 10 3 /μL because of platelet transfusion practices in our neonatal intensive care units and the relatively small number of the more clinically relevant bleeding grades (ie, 3-4). The limited number of CT-ADPs obtained in each infant was because of the relatively high blood volume required by the test (800 μL). We also recognize that all associations presented may be subject to residual or unmeasured confounding variables.Platelet transfusions given at the thresholds used in this study increased PCs but did not reduce BSs. This was consistent with the Platelet Transfusion Thresholds in Premature Neonates (PlaNeT-2) study, in which PTX for PCs less 50 × 10 3 /μL did not reduce bleeding. 6 Together, these findings suggest that when PCs are not extremely low, other factors could be contributors to bleeding in neonates with thrombocytopenia, although the PC threshold below which a PTX reduces bleeding is unknown. Overall, 8 infants in our cohort also received 9 fresh frozen plasma transfusions for clinical bleeding. However, these transfusions did not reduce CT-ADP or BS and did not affect their association. Implementing CT-ADP or other measures of primary hemostasis in clinical practice may lead to novel approaches to manage thrombocytopenia in preterm neonates.

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Evaluation of the Association of Platelet Count, Mean Platelet Volume, and Platelet Transfusion With Intraventricular Hemorrhage and Death Among Preterm Infants

Chen

et al. 2022

JAMA Netw Open

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ImportancePlatelet transfusion is commonly performed in infants to correct severe thrombocytopenia or prevent bleeding. Exploring the associations of platelet transfusion, platelet count (PC), and mean platelet volume (MPV) with intraventricular hemorrhage (IVH) and in-hospital mortality in preterm infants can provide evidence for the establishment of future practices.ObjectivesTo evaluate the associations of platelet transfusion, PC, and MPV with IVH and in-hospital mortality and to explore whether platelet transfusion–associated IVH and mortality risks vary with PC and MPV levels at the time of transfusion.Design, Setting, and ParticipantsThis retrospective cohort study included preterm infants who were transferred to the neonatal intensive care unit on their day of birth and received ventilation during their hospital stay. The study was conducted at a neonatal intensive care unit referral center in Beijing, China, between May 2016 and October 2017. Data were retrieved and analyzed from December 2020 to January 2022.ExposuresPlatelet transfusion, PC, and MPV.Main Outcomes and MeasuresAny grade IVH, severe IVH (grade 3 or 4), and in-hospital mortality.ResultsAmong the 1221 preterm infants (731 [59.9%] male; median [IQR] gestational age, 31.0 [29.0-33.0] weeks), 94 (7.7%) received 166 platelet transfusions. After adjustment for potential confounders, platelet transfusion was significantly associated with mortality (hazard ratio [HR], 1.48; 95% CI, 1.13-1.93; P = .004). A decreased PC was significantly associated with any grade IVH (HR per 50 × 103/μL, 1.13; 95% CI, 1.05-1.22; P = .001), severe IVH (HR per 50 × 103/μL, 1.16; 95% CI, 1.02-1.32; P = .02), and mortality (HR per 50 × 103/μL, 1.74; 95% CI, 1.48-2.03; P &lt; .001). A higher MPV was associated with a lower risk of mortality (HR, 0.83; 95% CI, 0.69-0.98; P = .03). The platelet transfusion–associated risks for both IVH and mortality increased when transfusion was performed in infants with a higher PC level (eg, PC of 25 × 103/μL: HR, 1.20; 95% CI, 0.89-1.62; PC of 100 × 103/μL: HR, 1.40; 95% CI, 1.08-1.82). The platelet transfusion–associated risks of IVH and mortality varied with MPV level at the time of transfusion.Conclusions and RelevanceIn preterm infants, platelet transfusion, PC, and MPV were associated with mortality, and PC was also associated with any grade IVH and severe IVH. The findings suggest that a lower platelet transfusion threshold is preferred; however, the risk of a decreased PC should not be ignored.

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Prospective, Observational Study of Outcomes in Neonates With Severe Thrombocytopenia

Abstract: Although one third of neonates enrolled in this study developed thrombocytopenia of <20 x 10(9) platelets per L, 91% did not develop major hemorrhage. Most platelet transfusions were given to neonates with thrombocytopenia with no bleeding or minor bleeding only.

Cited by 156 publications

References 30 publications

Thrombocytopenia in Small-for-Gestational-Age Infants

Thrombocytopenia in Small-for-Gestational-Age Infants

Association of Bleeding Scores and Platelet Transfusions With Platelet Counts and Closure Times in Response to Adenosine Diphosphate (CT-ADPs) Among Preterm Neonates With Thrombocytopenia

Evaluation of the Association of Platelet Count, Mean Platelet Volume, and Platelet Transfusion With Intraventricular Hemorrhage and Death Among Preterm Infants

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