Baer Vickie L, Lambert Diane K, Henry Erick, Christensen Robert D
Department of Women and Newborns, Intermountain Healthcare, Salt Lake City, Utah 84403, USA.
Pediatrics. 2009 Dec;124(6):e1095-100. doi: 10.1542/peds.2009-0582. Epub 2009 Nov 16.
Severe thrombocytopenia (platelets <or= 50000/microL) in a NICU patient can have significant consequences; however, previous reports have not focused exclusively on NICU patients with counts this low.
We identified all patients with severe thrombocytopenia who were cared for in the Intermountain Healthcare level III NICUs from 2003-2007.
Among 11281 NICU admissions, severe thrombocytopenia was identified in 273 (2.4%). Just over 30% of these presented in the first three days of life. Half presented by day 10, 75% by day 27, and 95% by day 100. The prevalence was inversely related to birth weight. Cutaneous bleeding was more common in patients with platelet counts of <20000/microL; however, no statistically significant correlation was found between platelet counts and pulmonary, gastrointestinal, or intraventricular bleeding. The most common explanations for severe thrombocytopenia were acquired varieties of consumptive thrombocytopenia. Platelet transfusions (median 5, range 0-76) were administered to 86% of the patients. No deaths were ascribed to exsanguinations. The mortality rate did not correlate with the lowest platelet count but was proportionate to the number of platelet transfusions.
The prevalence of severe thrombocytopenia in the NICU is inversely proportional to birth weight and most cases are acquired consumptive thrombocytopenias. We speculate that very low platelet counts are a causal factor in cutaneous bleeding, but pulmonary, gastrointestinal, and intraventricular bleeding are less influenced by the platelet count and occur primarily from causes other than severe thrombocytopenia. The lowest platelet count does not predict the mortality rate but the number of platelet transfusions received does.
新生儿重症监护病房（NICU）患者出现严重血小板减少症（血小板计数≤50000/微升）可能会产生严重后果；然而，既往报告并未专门聚焦于血小板计数如此之低的NICU患者。
我们确定了2003年至2007年在山间医疗保健三级NICU接受治疗的所有严重血小板减少症患者。
在11281例NICU入院病例中，273例（2.4%）被确定为严重血小板减少症。其中略多于30%在出生后三天内出现。半数在出生后第10天出现，75%在第27天出现，95%在第100天出现。患病率与出生体重呈负相关。血小板计数<20000/微升的患者皮肤出血更为常见；然而，血小板计数与肺部、胃肠道或脑室内出血之间未发现统计学上的显著相关性。严重血小板减少症最常见的原因是获得性消耗性血小板减少症。86%的患者接受了血小板输注（中位数为5，范围为0至76）。没有死亡归因于失血。死亡率与最低血小板计数无关，但与血小板输注次数成正比。
NICU中严重血小板减少症的患病率与出生体重成反比，且大多数病例为获得性消耗性血小板减少症。我们推测血小板计数极低是皮肤出血的一个致病因素，但肺部、胃肠道和脑室内出血受血小板计数的影响较小，主要由严重血小板减少症以外的原因引起。最低血小板计数不能预测死亡率，但接受的血小板输注次数可以。
