Charoo Bashir A, Iqbal Javeed I, Iqbal Qazi, Mushtaq Sheikh, Bhat Abdul W, Nawaz Imtiyaz
Department of Pediatrics, Sher-I-Kashmir Institute Of Medical Sciences Soura Srinagar Jammu and Kashmir, India.
Hematol Oncol Stem Cell Ther. 2009;2(2):349-53. doi: 10.1016/s1658-3876(09)50024-6.
Late onset sepsis (LOS)( onset of sepsis >72 hours of age or nosocomial sepsis) is an important cause of morbidity and mortality in the neonatal intensive care unit (NICU). Thrombocytopenia is an important complication of sepsis. We investigated the incidence of thrombocytopenia in LOS patients and studied the influence of various parameters on platelet response.
Infants born in the level 3 neonatal intensive care unit between January 2002 and December 2006 with documented LOS were included in this prospective study. Multiple hemograms with platelet counts, bacterial blood culture and fungal blood culture were obtained in all patients. Demographic and clinical data were compared between patients without thrombocytopenia and with mild, moderate and severe thrombocytopenia. Duration of thrombocytopenia in relation to type of organism and mortality with respect to degree of thrombocytopenia were also studied.
Of 200 patients with culture-proven nosocomial sepsis, 119 (59.5%) patients developed thrombocytopenia (platelet count <150 X 109/L). In our series Klebsiella pneumoniae was the most frequently isolated organism (125/200, 62.5%) and the incidence of thrombocytopenia was 60.0% (75/125). However, the incidence of thrombo- cytopenia was highest among patients who had concurrent bacterial and fungal sepsis (28/31, 90.3%). Coagulase- negative staphylococcal (CoNS) sepsis was present in 21 (10.5%) patients and the incidence of thrombocytopenia was 33.3%. Isolated fungal sepsis was present only in 6 (3%) patients and the incidence of thrombocytopenia was 66.0%. The incidence of thrombocytopenia was highest among preterm babies and low-birth weight (LBW) babies. Twenty-seven percent (54/200) of babies presented with mild thrombocytopenia, 20% (40/200) presented with moderate thrombocytopenia, and 12.5%(25/200) developed severe thrombocytopenia. Severity of thrombocytopenia was also directly related to the presence of necrotizing enterocolitis (NEC) and disseminated intravascular coagulation (DIC). The mortality rate was significantly associated with the degree of thrombocytopenia.
LOS sepsis is an important risk factor for thrombocytopenia in the NICU. Fungal and gram- negative sepsis are frequently associated with a decreased platelet count. Sepsis-induced thrombocytopenia is more common among LBW babies and preterm babies. The mortality rate is significantly related to degree of thrombocytopenia.
迟发性败血症（LOS）（败血症发病年龄>72小时或医院获得性败血症）是新生儿重症监护病房（NICU）发病和死亡的重要原因。血小板减少是败血症的重要并发症。我们调查了LOS患者血小板减少的发生率，并研究了各种参数对血小板反应的影响。
纳入2002年1月至2006年12月在三级新生儿重症监护病房出生且有记录的LOS婴儿进行这项前瞻性研究。所有患者均进行了多次血细胞计数及血小板计数、血细菌培养和血真菌培养。比较无血小板减少患者与轻度、中度和重度血小板减少患者的人口统计学和临床数据。还研究了血小板减少的持续时间与病原体类型的关系以及血小板减少程度与死亡率的关系。
在200例经培养证实的医院获得性败血症患者中，119例（59.5%）发生了血小板减少（血小板计数<150×10⁹/L）。在我们的系列研究中，肺炎克雷伯菌是最常分离出的病原体（125/200，62.5%），血小板减少的发生率为60.0%（75/125）。然而，同时发生细菌和真菌败血症的患者中血小板减少的发生率最高（28/31，90.3%）。凝固酶阴性葡萄球菌（CoNS）败血症患者有21例（10.5%），血小板减少的发生率为33.3%。仅6例（3%）患者为单纯真菌败血症，血小板减少的发生率为66.0%。血小板减少的发生率在早产儿和低体重（LBW）儿中最高。27%（54/200）的婴儿为轻度血小板减少，20%（40/200）为中度血小板减少，12.5%（25/200）发生重度血小板减少。血小板减少的严重程度也与坏死性小肠结肠炎（NEC）和弥散性血管内凝血（DIC）的存在直接相关。死亡率与血小板减少的程度显著相关。
LOS败血症是NICU中血小板减少的重要危险因素。真菌和革兰阴性菌败血症常与血小板计数降低有关。败血症诱导的血小板减少在LBW儿和早产儿中更常见。死亡率与血小板减少的程度显著相关。
