Incidence and risk factors of neonatal thrombocytopenia: a preliminary study
Background Thrombocytopenia is the most common hematological abnormality in the neonatal period. Hemorrhagic manifestations are found in 10% cases of thrombocytopenia. Neonatal thrombocytopenia commonly assumed due to sepsis, despite many risk factors that may caused thrombocytopenia.
Objective To obtain incidence and risk factors of neonatal thrombocytopenia.
Methods A cross sectional study was conducted in April 2009. Complete blood counts investigation was performed before age of 24 hours, medical conditions and risk factors of mothers and subjects were noted, as well as hemorrhagic manifestations. Subjects with thrombocytopenia were followed for 2 weeks. The risk factors consisted of hypertension in pregnancy, pre-eclampsia, eclampsia, intrauterine growth retardation, gestational diabetes mellitus, perinatal infection, asphyxia, sepsis, and necrotizing enterocolitis.
Results Neonatal thrombocytopenia was found 17 (12.1%) of 140 subjects, consisted of 88.2% early onset and 11.8% late onset. Significant risk factor of mother was pre-eclampsia (PR 3.97, 95%CI 1.70 to 9.25), while significant risk factors of neonates were asphyxia (PR 5.66, 95%CI 2.49 to 12.86), sepsis (PR 5.33, 95%CI 2.33-12.19) and necrotizing enterocolitis (p=0.014; PR 9.2 95% CI 5.17 to14.84). We found 29.4% hemorrhagic cases of neonatal thrombocytopenia (i.e.,. skin, gastrointestinal, intracranial hemorrhage).
Conclusions The incidence of neonatal thrombocytopenia was 12.2%. Significant risk factor of mother that caused thrombocytopenia was pre-eclampsia, while risk factors of neonates were asphyxia, sepsis and necrotizing enterocolitis.[Paediatr Indones. 2010;50:31-7].
2. Forestier F, Daffos F, Catherine N, Renard M, Andreux JP. Developmental hematopoiesis in normal human fetal blood. Blood. 1991;77:2360-3.
3. B Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med. 1993;329:1463-6.
4. U Uhrynowska M, Niznikowska-Marks M, Zupanska B. Neonatal and maternal thrombocytopenia: incidence and immune background. Eur J Haematol. 2000;64:42-6.
5. Dreyfus M, Kaplan C, Verdy E, Schlegel N, Durand-Zaleski I, Tchernia G. The Immune Thrombocytopenia Working Group. Frequency of immune thrombocytopenia in newborns: a prospective study. Blood. 1997;89:4402-6.
6. de Moerloose P, Boehlen F, Exterman P, Hochfeld P. Neonatal thrombocytopenia: incidence and characterization of maternal antiplatelet antibodies by MAIPA assay. Br J Haematol. 1998;100:735-40.
7. Roberts I, Murray NA. Neonatal thrombocytopenia: causes and management. Arch Dis Child Fetal Neonatal Ed. 2003;88:359-64.
8. Brazy JE, Grimm JK, Durham NC, Little VA. Neonatal manifestations of severe maternal hypertension occurring before the thirty-sixth week of pregnancy. J Pediatr. 1982;100:265-71.
9. Wong W, Glader B. Approach to the newborn who has thrombocytopenia. NeoReviews. 2004;5:e444-9.
10. Tsao PN, Wei SC, Su YN, Chou HC, Chen CY, Hsieh WS. Excess soluble fms-like tyrosine kinase 1 and low platelet counts in premature neonates of preeclamptic mothers. Pediatrics. 2005; 116:468-72.
11. M Maynard SE, Min JY, Merchan J, Lim KH, Li J, Mondal S, et al. Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest. 2003;111:649-58.
12. Andrew M, Castle V, Saigal S, Carter C, Kelton JG. Clinical impact of neonatal thrombocytopenia. J Pediatr. 1987;110:457-64.
13. Jack W. Perinatal asphyxia. [cited on 2009 July 6]. Available from:: http://gufcm.georgetown.edu/welchij/netscut/neonatology/perinatalasphyxia.htm1997
14. M Modanlou HD, Ortiz OB . Thrombocytopenia in neonatal infection. Clin Pediatr. 1981;20:402-7.
15. Springer SC. Necrotizing enterocolitis. [cited on 2009 June 15]. Available from: http://www.emedicine.com.
16. M Mehta P, Rohitkumar V, Neumann L, Karpatkin M. Thrombocytopenia in the high risk infant. J Pediatr. 1980;97:791-4.
17. Danni ME. Karakteristik dan angka kejadian perdarahan germinal matrix intraventrikular pada neonatus kurang bulan di unit perawatan neonatus, Rumah Sakit Umum Pusat Dr. Cipto Mangunkusumo, Jakarta[Thesis]. Jakarta: Departemen Ilmu Kesehatan Anak FKUI-RSCM; 2008.
18. Volpe J. Germinal matrix-intraventrikular hemorrhage of the
Paediatr Indones, Vol. 50, No. 1, January 2010 â€¢ 37
Nila Kusumasari et al: Incidence and risk factors of neonatal thrombocytopenia
premature infant. In: Volpe J, editor. Neurology of newborn. 4th Ed. Philadelphia: WB Saunders, 2001; p.428-81.
19. Gupta SN, Kechli AM, KanamallaUS. Intracranial hemoorhage in term newborns: management and outcomes. Pediatr Neurol. 2009;40:1-12.
20. Chadwick LM, Pemberton PJ, Kurinczuk JJ. Neonatal subgaleal haematoma: associated risk factors, complications and outcome. J Paediatr Child Health. 1996;32:228-32.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.