Departments of Obstetrics and.
Pediatrics. 2014 Apr;133(4):715-21. doi: 10.1542/peds.2013-3320. Epub 2014 Mar 3.
Neonatal alloimmune thrombocytopenia (NAIT) is a potentially devastating disease that may lead to intracranial hemorrhage in the fetus or neonate, often with death or major neurologic damage. There are no routine screening programs for NAIT, preventive measures are taken only in a subsequent pregnancy. To estimate the population incidence of NAIT and its consequences, we conducted a review of the literature. Our results may aid in the design of a screening program.
An electronic literature search included Medline, Embase, Cochrane database and references of retrieved articles. Eligible for inclusion were all prospective studies aimed at diagnosing NAIT in a general, nonselected newborn population, with sufficient information on platelet count at birth, bleeding complications, and treatment. Titles and abstracts were reviewed, followed by review of full text publications. Studies were independently assessed by 2 reviewers for methodologic quality. Disagreements were resolved by consensus, including a third reviewer.
From the initial 768 studies, 21 remained for full text analysis, 6 of which met the inclusion criteria. In total, 59,425 newborns were screened, with severe thrombocytopenia in 89 cases (0.15%). NAIT was diagnosed in 24 of these 89 newborns (27%). In 6 (25%) of these cases, an intracranial hemorrhage was found, all likely of antenatal origin.
NAIT is among the most important causes of neonatal thrombocytopenia. Intracranial hemorrhage due to NAIT occurs in 10 per 100 000 neonates, commonly before birth. Screening for NAIT might be effective but should be done antenatally.
新生儿同种免疫性血小板减少症（NAIT）是一种潜在的破坏性疾病，可能导致胎儿或新生儿颅内出血，常导致死亡或严重神经损伤。目前尚无针对 NAIT 的常规筛查计划，只能在后续妊娠中采取预防措施。为了评估 NAIT 的人群发病率及其后果，我们对文献进行了回顾。我们的研究结果可能有助于设计筛查计划。
电子文献检索包括 Medline、Embase、Cochrane 数据库和检索文章的参考文献。符合纳入标准的是所有旨在诊断一般非选择性新生儿人群中 NAIT 的前瞻性研究，且研究必须提供足够的出生时血小板计数、出血并发症和治疗信息。首先对标题和摘要进行审查，然后对全文出版物进行审查。由 2 名评审员独立评估方法学质量。通过共识解决分歧，包括由第 3 名评审员参与。
从最初的 768 项研究中，有 21 项研究进行了全文分析，其中 6 项符合纳入标准。共有 59425 名新生儿接受了筛查，其中 89 例（0.15%）严重血小板减少。在这 89 例新生儿中，诊断出 24 例 NAIT（27%）。在这些病例中，有 6 例（25%）发现颅内出血，均可能为产前起源。
NAIT 是新生儿血小板减少症的最重要原因之一。由于 NAIT 导致的颅内出血每 10 万新生儿中就有 10 例发生，通常发生在产前。NAIT 的筛查可能有效，但应在产前进行。
