Am J Perinatol 2003; 20(1): 049-054
DOI: 10.1055/s-2003-37948
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Risk Factors for Neonatal Thrombocytopenia in Preterm Infants

Mario E. Beiner1 , Michal J. Simchen1 , Eyal Sivan1 , Angela Chetrit2 , Jacob Kuint3 , Eyal Schiff1
  • 1Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Israel
  • 2Department of Clinical Epidemiology, The Chaim Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Israel
  • 3Department of Neonatology, The Chaim Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Israel
Further Information

Publication History

Publication Date:
14 March 2003 (online)

ABSTRACT

The objective of this study is to identify the risk factors for neonatal thrombocytopenia among preterm infants. During a 4-year study period all consecutive, singleton preterm deliveries (between 27 and 35 weeks of gestation) were evaluated, and separate cohorts were compared-growth restricted (small-for-gestational-age; SGA) and appropriately grown (appropriate-for-gestational-age; AGA) infants. An initial comparison was done for the presence of thrombocytopenia (platelet count below 150,000/mL) and marked thrombocytopenia (below 100,000/mL). Following that, a comparison was made between the groups as determined by platelet count for various possible risk factors. Three hundred and five preterm infants were included in the study. Mean platelet count was significantly lower in the SGA group (p = 0.0009). Ninety-three neonates (31%) were thrombocytopenic and 212 infants with a normal platelet count served as controls. In the thrombocytopenic group, the rate of preeclampsia was significantly higher (p = 0.002). Thrombocytopenic infants had a significantly lower average gestational age at delivery (p = 0.002), lower birth weight (p = 0.0001), and low 5-minute Apgar score (p = 0.0002). They were more likely to suffer from intraventricular hemorrhage (IVH) (p = 0.04) and sepsis (p = 0.002). Growth restriction, lower gestational age and low 5-minute Apgar score (<7) were found to be significantly independent risk factors for marked thrombocytopenia, when analyzed separately. Growth restriction, lower gestational age at delivery, and low 5-minutes Apgar score are significantly associated with neonatal thrombocytopenia in preterm infants, which may lead to significant morbidity. Screening these high-risk groups for thrombocytopenia might be beneficial in terms of early diagnosis and management.

REFERENCES

  • 1 Millar D S, Davis L R, Rodeck C H, Nicolaides K H. Normal blood cell values in the early mid-trimester fetus.  Prenat Diagn . 1985;  2 367-373
  • 2 Van den Hof C M, Nicolaides K H. Platelet count in normal, small, and anemic fetuses.  Am J Obstet Gynecol . 1990;  162 735-739
  • 3 Forestier F, Daffos F, Catherine N, Renard M, Andreux J P. Developmental hematopoiesis in normal human fetal blood.  Blood . 1991;  77 2360-2363
  • 4 Ören H, Irken G, Ören B, Olgun N, Ozkan H. Assessment of clinical impact and predisposing factors for neonatal thrombocytopenia.  Indian J Pediatr . 1994;  61 551-558
  • 5 Mehta P, Vasa R, Neumann L, Karpatkin M. Thrombocytopenia in the high-risk infant.  J Pediatr . 1980;  97 791-794
  • 6 Andrew M, Castle V, Saigal S, Carter C, Kelton J G. Clinical impact of neonatal thrombocytopenia.  J Pediatr . 1987;  110 457-464
  • 7 Castle V, Andrew M, Kelton J, Giron D, Johnston M, Carter C. Frequency and mechanism of neonatal thrombocytopenia.  J Pediatr . 1986;  108 749-756
  • 8 Simchen M J, Beiner M E, Strauss-Liviathan N, Dulitzki M, Kuint J, Mashiach S. et al . Neonatal outcome in growth-restricted versus appropriately grown preterm infants.  Am J Perinat . 2000;  17 171-176
  • 9 Leiberman J R, Fraser D, Weitzman S, Glezerman M. Birthweight curves in southern Israel population.  Isr J Med Sci . 1993;  29 198-203
  • 10 Roberts I AG, Murray N A. Neonatal thrombocytopenia: new insights into pathogenesis and implications for clinical management.  Curr Opin Pediatr . 2001;  13 16-21
  • 11 Murray N A, Roberta A IG. Circulating megakaryocytes and their progenitors in early thrombocytopenia in preterm neonates.  Pediatr Res . 1996;  40 112-119
  • 12 Shuper A, Mimuoni F, Merlob P, Zaizov R, Reisner S H. Thrombocytopenia in small-for-gestational-age infants.  Acta Pediatr Scand . 1983;  72 139-140
  • 13 Hohfeld P, Forestier F, Kaplan C, Tissot J D, Daffos F. Fetal thrombocytopenia: a retrospective survey of 5,194 fetal blood samplings.  Blood . 1994;  84 1851-1856
  • 14 Sola M C, Calhoun D A, Huston A D. et al . Plasma thrombopoietin concentrations in thrombocytopenic and non-thrombocytopenic patients in a neonatal intensive care unit.  Br J Haematol . 1999;  104 90-92
  • 15 Murray N A, Watts T L, Roberts I AG. Endogenous thrombopoietin levels and effect of recombinant human thrombopoietin on megakaryocyte precursors in term and preterm babies.  Pediatr Res . 1998;  43 148-151
  • 16 Saino S, Jarvenpaa A-S, Renlund M. et al . Thrombocytopenia in term infants: a population-based study.  Obstet Gynecol . 2000;  95 441-446
  • 17 Uhrynowska M, Niznikowska-Marks M, Zupanska B. Neonatal and maternal thrombocytopenia: incidence and immune background.  Eur J Haematol . 2000;  64 42-46