Factors Associated With Thrombocytopenia in Neonatal Sepsis

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Severe thrombocytopenia shows an increased association with major hemorrhages and mortality.
Severe thrombocytopenia shows an increased association with major hemorrhages and mortality.

Thrombocytopenia in neonatal sepsis was shown to be associated with maternal hypertension, intravascular thrombosis, and Gram-negative sepsis, according to the results of a recent study published in PLoS One.

Infants admitted to the neonatal intensive care unit with culture-confirmed sepsis were evaluated for thrombocytopenia (n=460). The occurrence, severity, and duration of thrombocytopenia were evaluated, as were major bleeding events and risk factors for mortality.

Of the 460 neonates with sepsis, 92 (20%) had severe thrombocytopenia (platelets <50 x 109/L). Median time to platelet counts >100x109/L was 6 days.

Severe thrombocytopenia was more common in infants with Gram-negative sepsis compared with Gram-positive sepsis (42% vs 17%; P <.001). Furthermore, median platelet counts were lower in patients with Gram-negative sepsis compared with Gram-positive sepsis (28x109/L vs 66x109/L).

In multivariate analysis, the following were independently associated with thrombocytopenia in neonates: maternal hypertension (OR 1.76; P =.021), intravascular thrombosis (OR 4.98; P =.005), and Gram-negative sepsis (OR compared with Gram-positive 2.74; P =.003).

Intraventricular hemorrhage and pulmonary hemorrhage were more common in infants with severe thrombocytopenia compared with infants with platelet counts >50x109/L (P =.031). Furthermore, mortality was increased in neonates with severe thrombocytopenia compared with infants without (P =.001). Both thrombocytopenia (OR 3.77; P =.012) and Gram-negative sepsis (OR 6.01; P <.001) were independently associated with mortality.

In an interview with Infectious Disease Advisor, Isabelle Ree, PhD candidate at Leiden University Medical Center in The Netherlands and lead study investigator, explained that the results of the study "shed a broader light on the complex relationship between thrombocytopenia and sepsis." She concluded that "it is unclear whether thrombocytopenia in sepsis is merely a marker of sepsis severity, but the occurrence of thrombocytopenia in sepsis is clearly associated with mortality and should therefore be considered as an alarming and serious condition."

Reference

Ree IMC, Fustolo-Gunnink SF, Bekker V, Fijnvandraat KJ, Steggerda SJ, Lopriore E. Thrombocytopenia in neonatal sepsis: incidence, severity and risk factors. PLoS One. 2017;12(10):e0185581.

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