A total of 870 neonates who were admitted in Neonatal Intensive Care Unit (NICU) with various morbidities had platelets count done. Of these, 146 (16.7%) neonates showed platelet count less than 100 × 109/l and consisted of 70, 40, and 36 in group I, II, and III, respectively .
Thrombocytopenia in neonates was analyzed in relation to birth weight and gestational age of neonates [Tables and ]. Platelet count was significantly lower in low birth weight (LBW) babies having birth weight < 1500 g than babies with birth weight > 2500 g (169400 ± 87200 vs. 200100 ± 88300). About, 44.4% babies in LBW group experienced thrombocytopenia. Gestational age showed no effect on neonatal thrombocytopenia. Although 45% and 36% premature neonates in geastational age of <30 weeks and 31–35 weeks, respectively, showed decrease in platelet count, but statistical analysis showed no significance (P 0.054).
Platelet count in relation to birth weight of neonates (= 870)
Platelet count in relation to gestational age of neonates (= 870)
Of maternal factors, platelet count was significantly lower in neonates born with mother with hypertensive disorders of pregnancy (HDP) . Maternal hypertension was present in 220 cases and a significant cause for lower platelet count (180400 ± 84100 vs. 190600 ± 85500, P 0.04). Mean platelet count decreased with the severity of HDP. HDP noted in 64 cases of thrombocytopenia; of these 15 had platelets count < 30 × 109/l. 135 neonates with intrauterine growth retardation (IUGR) diagnosed during antenatal screening showed lower platelet count (172900 ± 79400 vs. 191000 ± 73600, P 0.022). Details of antenatal screening were not available in five cases. No association was noted for fetal distress, antepartum hemorrhage, maternal diabetes, parity, prolonged leaking, and type of delivery.
Platelet count and associated perinatal problems (= 870)
Among 146 thrombocytopenic neonates, sepsis was observed in 81.5% (119), GI problems in 57.7% (80), respiratory problem (delayed cry, meconium) in 43.1% (63), and intracranial hemorrhage in 13.6% (20) either alone or in combination . In addition, 41.7% (61) neonates received inotropic support. Clinical sepsis lowered the platelet count (21819 ± 21268 vs. 49256 ± 21894), 41 had positive blood culture; 35 showed infection with gram-negative bacteria, 2 had shown growth of gram-positive bacteria, and 4 showed growth of Candida. Neonatal respiratory problems, ventilation, and neurological problems had an association with low platelet counts but showed no significance statistically. Neonatal gastrointestinal problems were significantly higher among thrombocytopenic babies (P 0.03); the later may be due to association with sepsis.
Thrombocytopenia and clinical conditions of neonates (= 146)
With regard to platelet transfusions, 16.4% (24) neonates were transfused with platelet, number being 13, 3, 5, 2, and 1 for 1, 2, 3, 4, and ≥5 units of platelet transfusion, respectively . It was given for babies with evident and anticipated bleeding tendency with severe thrombocytopenia. In addition, whole blood and fresh frozen Plasma (FFP) was transfused in 75.3% (110) and 53.4% (78) neonates, respectively, either alone or in association with platelet. Platelet transfusion was more in group III (70.8%) as compared to groups I and II.
Transfusions in thrombocytopenic neonates (= 146)