The relationship between thrombocytopenia and intraventricular hemorrhage in neonates with gestational age <35 weeks

  • Idha Yulandari Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Lily Rundjan Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Muzal Kadim Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Pustika Amalia Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Haryanti F. Wulandari Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Setyo Handryastuti Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
DOI: https://doi.org/10.14238/pi56.4.2016.242-50
Keywords: gestational age <35 weeks, intraventricular hemorrhage, thrombocytopenia.

Abstract

Background The prevalence of thrombocytopenia in neonates ranges from 22 to 35%, and one of the most feared complica­tions is intraventricular hemorrhage (IVH). Previous research in Cipto Mangunkusumo Hospital (CMH), Jakarta reported a high incidence of IVH (43.47%) in infants with a gestational age of <35 weeks. Intraventricular hemorrhage causes disturbances in neurological development and can be fatal. In Indonesia, re­search on the relationship between thrombocytopenia and IVH has been limited.

Objective To study the relationship between thrombocytopenia and IVH in neonates with gestational age <35 weeks and assess for a correlation between the severity of thrombocytopenia and the severity of IVH.

Methods This cross-sectional study was performed by reviewing medical records in the Neonatology Division of the Child Health Department, University of Indonesia, CMH. Subjects were neonates hospitalized from January 2012 to December 2014 with IVH. Subjects were categorized into either mild to moderate IVH (grade ≤2) or severe IVH (grade >2). Thrombocyte counts were recorded on the same day as the diagnosis of IVH.

Results The risk of severe IVH was 28.2% in neonates with thrombocyte counts <100,000/uL, and 10.4% in neonates without thrombocytopenia (P=0.014). Multivariate analysis revealed that gestational age <32 weeks and the use of respira­tory support (ventilator and high frequency oscillatory ventila­tion) had significant associations with severe IVH. However, multivariate analysis did not show a significant relationship between thrombocytopenia and severe IVH (correlation coef­ficient = 0.21).

Conclusion Thrombocytopenia is not significantly associated with the incidence of severe IVH based on multivariate analysis. Also, the severity of thrombocytopenia has no correlation with the severity of IVH.

References

1. von Lindern JS, van den Bruele T, Lopriore E, Walther FJ. Thrombocytopenia in neonates and the risk of intraventricular hemorrhage: a retrospective cohort study. BMC Pediatr. 2011;11:1-7.
2. Ment LR, Allan WC, Makuch RW, Vohr B. Grade 3 to 4 intraventricular hemorrhage and Bayley scores predict outcome. Pediatrics. 2005;116:1597-8.
3. Volpe J. Germinal matrix-intraventricular hemorrhage of the premature infant. In: Joseph J Volpe, editor. Neurology of newborn. 4th ed. Philadelphia: WB Saunders; 2001. p. 428-81.
4. Kahn DJ, Richardson DK, Billett HH. Association of thrombocytopenia and delivery method with intraventricular hemorrhage among very-low-birth-weight infants. Am J Obstet Gynecol. 2002;186:109-16.
5. Baer VL, Lambert DK, Henry E, Christensen RD. Severe thrombocytopenia in the NICU. Pediatrics. 2009;124:e1095-100.
6. Bolat F, Kiliç SÇ, Oflaz MB, Gülhan E, Kaya A, Güven AS, et al. The prevalence and outcomes of thrombocytopenia in a neonatal intensive care unit: a three-year report. Pediatr Hematol Oncol. 2012;29:710-20.
7. Andrew M, Castle V, Saigal S, Carter C, Kelton JG. Clinical impact of neonatal thrombocytopenia. J Pediatr. 1987;110:457-64.
8. Setzer ES, Webb IB, Wassenaar JW, Reeder JD, Mehta PS, Eitzman DV. Platelet dysfunction and coagulopathy in intraventricular hemorrhage in the premature infant. J Pediatr. 1982;100:599-605.
9. Lupton BA, Hill A, Whitfield MF, Carter CJ, Wadsworth LD, Roland EH. Reduced platelet count as a risk factor for intraventricular hemorrhage. Am J Dis Child. 1988;142: 1222-4.
10. Stanworth SJ, Clarke P, Watts T, Ballard S, Choo L, Morris T, et al. Prospective, observational study of outcomes in neonates with severe thrombocytopenia. Pediatrics. 2009;124:e826-34.
11. Kusumasari N, Rohsiswatmo R, Gatot D, Darwis D. Incidence and risk factors of neonatal thrombocytopenia: a preliminary study. Paediatr Indones. 2010;50:31-7.
12. 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 [dissertation]. [Jakarta]: Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia; 2008.
13. Rohsiswatmo R. Kontroversi diganosis sepsis neonatorum. In: Hegar B, Trihono PP, Ifran BE, editors. Update in neonatal infection. Jakarta: Bagian Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia; 2005. p. 32-43.
14. Dessi A, Pravettoni C, Ottonello G, Birochi F, Cioglia F, Fanos V. Neonatal sepsis. J Pediatr Neonat Individual Med. 2014;3:1-7.
15. Kosim MS. Syok pada bayi baru lahir. In: Kosim MS, Yunanto A, Dewi R, Sarosa GI, Usman A, editors. Buku ajar neonatologi. 1st ed. Jakarta: Badan Penerbit IDAI; 2008. p. 297-308.
16. Sajjadian N, Fakhrai H, Jahadi R. Incidence of intraventricular hemorrhage and post hemorrhagic hydrocephalus in preterm infants. Acta Med Iran. 2010;48:260-2.
17. Kim KR, Jung SW, Kim DW. Risk factors associated with germinal matrix-intraventricular hemorrhage in preterm neonates. J Korean Neurosurg Soc. 2014;56:334-7.
18. Pishva N, Parsa G, Saki F, Saki M, Saki MR. Intraventricular hemorrhage in premature infants and its association with pneumothorax. Acta Med Iran. 2012;50:473-6.
19. Khodapanahandeh F, Khosravi N, Larijani T. Risk factors for intraventricular hemorrhage in very low birth weight infants in Tehran, Iran. Turk J Pediatr. 2008;50:247-52.
20. Martins L, Borges MJ, Gomes SM, Macedo I, Nona J, Pinto F, et al. Intraventricular hemorrhage risk factors in very low birth weight newborns: a case-control study. Einstein. 2009;7:279-83.
21. Ballabh P. Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatr Res. 2010;67:1-8.
22. Linder N, Haskin O, Levit O, Klinger G, Prince T, Naor N, et al. Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study. Pediatrics. 2003;111:e590-5.
23. Aly H, Hammad T, Essers J, Wung JT. Is mechanical ventilation associated with intraventricular hemorrhage in preterm infants? Brain Dev. 2012;34:201-5.
24. Inder T, Volpe J. Intraventricular hemorrhage in the neonate. In: Polin R, Fox W, Abman S, editors. Fetal and neonatal physiology. 4th ed. Philadelphia: Saunders; 2011. p. 1830-47.
25. Schreiner C, Suter S, Watzka M, Hertfelder H, Schreiner F, Oldenburg J, et al. Genetic variants of the vitamin K dependent coagulation system and intraventricular hemorrhage in preterm infants. BMC Pediatr. 2014;14:219.
26. Al-Aweel I, Pursley DM, Rubin LP, Shah B, Weisberger S, Richardson DK. Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs. J Perinatol. 2001;21:272-8.
27. Pekcevik Y, Pasinli A, Ozer E, Erdogan N. Risk factors of germinal matrix intraventricular hemorrhage in premature infants. Iran J Pediatr. 2014;24:191-7.
28. Bada HS, Korones SB, Perry EH, Arheart KL, Ray JD, Pourcyrous M, et al. Mean arterial blood pressure changes in premature infants and those at risk for intraventricular hemorrhage. J Pediatr. 1990;117:607-14.
29. Brunner B, Hoeck M, Schermer E, Streif W, Kiechl-Kohlendorfer U. Patent ductus arteriosus, low platelets, cyclooxygenase inhibitors, and intraventricular hemorrhage in very low birth weight preterm infants. J Pediatr. 2013;163:23-8.
30. Bednarek FJ, Bean S, Barnard MR, Frelinger AL, Michelson AD. The platelet hyporeactivity of extremely low birth weight neonates is age dependent. Thromb Res. 2009;124:42-5.
31. Deschmann E, Sola-Visner M, Saxonhouse MA. Primary hemostasis in neonates with thrombocytopenia. J Pediatr. 2014;164:167-72.
32. Strauss T, Sidlik-Muskatel R, Kenet G. Developmental hemostasis: primary hemostasis and evaluation of platelet function in neonates. Semin Fetal Neonatal Med. 2011;16:301-4.
Published
2016-08-31
How to Cite
1.
Yulandari I, Rundjan L, Kadim M, Amalia P, Wulandari H, Handryastuti S. The relationship between thrombocytopenia and intraventricular hemorrhage in neonates with gestational age &lt;35 weeks. PI [Internet]. 31Aug.2016 [cited 20Apr.2024];56(4):242-0. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/773
Issue
Vol 56 No 4 (2016): July 2016
Section
Articles

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.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Received 2016-10-03
Accepted 2016-10-03
Published 2016-08-31