Abstract

A Study on Risk Factors, Immediate Outcome and a Short Term Follow Up Study of Neonates With Neonatal Thrombocytopenia

Background: Neonatal Thrombocytopenia, a platelet count <1.5 lakhs/µL is one of the most common hematological problems in a Neonatal Intensive Care Unit (NICU), with 18%-35% prevalence. More common among ELBW or Preterm babies (GA<or=32-36 weeks) or Sick neonates. Whereas, only 2% are thrombocytopenic at birth in term NB, and Severe Thrombocytopenia (platelet count <50,000 /µL) occurs in less than 3/1000 term infants. Objectives: To determine etiology, various comorbid conditions, onset, clinical features, immediate outcome, and a short term follow up of the Neonates. Methods: It was a Prospective Observational Study done with 140 neonates from May 2021 to Jun 2022, admitted to the NICU of a Tertiary Level Medical College Hospital in South Tamil Nadu, India. Neonates showing bleeding/having platelet count (<1.5 Lakhs/µL) were selected. Initial platelet count done on admission and counts repeated 12 hours after any therapeutic intervention. Treatment was given as per NICU protocols. Results: Mucosal bleed was the most common presentation. Severe Thrombocytopenia (<50,000/µL) was present in 08.5%, Moderate (<100,000/µL and ³ 50,000/µL) in 17%.45. 33% were preterm, 23% IUGR, 29% were LBW, 51.3% had Septicemia, 29.4% Birth asphyxia, 19% MAS, 11.1% DIC and 14% had NEC. 33.3% presented early (<72hrs) and 60% presented late (>72hrs). 21.5% of EOS and 55% of LOS developed severe thrombocytopenia. 22.33% were given Platelet Concentrate. Mortality was 37% in the Severe and 3.9% in the Moderate thrombocytopenia group. A significant association was observed with Maternal PIH, LOS, NEC, and Sepsis with DIC. Prematurity, IUGR, and Birth asphyxia were commonly associated with morbidities. Factors leading to Birth asphyxia and Sepsis directly influence platelet counts. Conclusion: Severe thrombocytopenia, in sick neonates in NICU, is a poor prognostic indicator.

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