Sola-Visner Martha, Saxonhouse Matthew A, Brown Rachel E
Drexel University College of Medicine, and St. Christopher's Hospital for Children, Drexel University Neonatology Research at MCP, Philadelphia, PA 19129, United States.
Early Hum Dev. 2008 Aug;84(8):499-506. doi: 10.1016/j.earlhumdev.2008.06.004. Epub 2008 Aug 5.
The evaluation and management of thrombocytopenia is a frequent challenge for neonatologists, as it affects 22-35% of infants admitted to the neonatal intensive care unit. Multiple disease processes can cause neonatal thrombocytopenia, and these can be classified as those inducing early thrombocytopenia (< or =72 h of life) and those inducing late-onset thrombocytopenia (>72 h). Most cases of neonatal thrombocytopenia are mild to moderate, and do not warrant intervention. In approximately 25% of affected neonates, however, the platelets count is <50 x 10(9)/L, and therapy with platelet transfusions is considered to decrease the risk of hemorrhage. The existing evidence to establish platelet transfusion triggers in neonates is very limited, but it suggests that transfusing platelets to non-bleeding neonates with platelet counts >50 x 10(9)/L does not decrease the risk of intraventricular hemorrhage (IVH), and that 30 x 10(9)/L might be an adequate threshold for stable non-bleeding neonates. However, adequately powered multi-center studies are needed to conclusively establish the safety of any given set of neonatal transfusion guidelines.
血小板减少症的评估与管理是新生儿科医生经常面临的挑战，因为它影响着22%至35%入住新生儿重症监护病房的婴儿。多种疾病过程可导致新生儿血小板减少症，这些可分为导致早期血小板减少症（出生后≤72小时）和导致迟发性血小板减少症（出生后>72小时）的情况。大多数新生儿血小板减少症病例为轻度至中度，无需干预。然而，在大约25%受影响的新生儿中，血小板计数<50×10⁹/L，输注血小板治疗被认为可降低出血风险。确定新生儿血小板输注触发阈值的现有证据非常有限，但表明给血小板计数>50×10⁹/L的无出血新生儿输注血小板不会降低脑室内出血（IVH）的风险，对于稳定的无出血新生儿，30×10⁹/L可能是一个合适的阈值。然而，需要有足够样本量的多中心研究来最终确定任何一套特定新生儿输血指南的安全性。
