Department of Pediatrics, Tokat Gaziosmanpaşa University School of Medicine, Tokat, Turkey
Department of Biostatistics, Tokat Gaziosmanpaşa University School of Medicine, Tokat, Turkey
Balkan Med J. 2020 Apr 10;37(3):150-156. doi: 10.4274/balkanmedj.galenos.2020.2019.7.47. Epub 2020 Feb 11.
BACKGROUND: Neonatal thrombocytopenia is a common hematological abnormality that occurs in 20–35% of all newborns in the neonatal intensive care unit. Platelet transfusion is the only known treatment; however, it is the critical point to identify neonates who are really at risk of bleeding and benefit from platelet transfusion as it also has various potential harmful effects. AIMS: To investigate the prevalence and risk factors of neonatal thrombocytopenia and its relationship to intraventricular hemorrhage in the neonatal intensive care unit and to determine whether the use of platelet mass index-based criteria could reduce the rate of platelet transfusion. STUDY DESIGN: Retrospective cohort study. METHODS: This study was conducted in the neonatal intensive care unit of a tertiary university hospital. The medical records of neonates in the neonatal intensive care unit with platelet counts <150×10/L between January 2013 and July 2016 were analyzed. RESULTS: During the study period, 2,667 patients were admitted to the neonatal intensive care unit, and 395 (14%) had thrombocytopenia during hospitalization. The rate of intraventricular hemorrhage was 7.3%. Multiple logistic regression analysis showed that although lower platelet counts were associated with a higher intraventricular hemorrhage rate, the effects of respiratory distress syndrome, sepsis, and patent ductus arteriosus were more prominent than the degree of thrombocytopenia. Thirty patients (7%) received platelet transfusion, and these patients showed a significantly higher mortality rate than their non-platelet transfusion counterparts (p<0.001). In addition, it was found that the use of platelet mass index-based criteria for platelet transfusion in our patients would reduce the rate of platelet transfusion by 9.5% (2/21). CONCLUSION: Neonatal thrombocytopenia is usually mild and often resolves without treatment. As platelet transfusion is associated with an increased mortality rate, its risks and benefits should be weighed carefully. The use of platelet mass index-based criteria may reduce platelet transfusion rates in the neonatal intensive care unit, but additional data from prospective studies are required.
背景：新生儿血小板减少症是一种常见的血液学异常，在新生儿重症监护病房中，约有 20-35%的新生儿会出现这种情况。血小板输注是唯一已知的治疗方法；然而，确定真正有出血风险并受益于血小板输注的新生儿是至关重要的，因为血小板输注也有各种潜在的有害影响。
目的：调查新生儿血小板减少症的患病率和危险因素及其与新生儿重症监护病房内颅内出血的关系，并确定是否可以使用血小板质量指数为基础的标准来降低血小板输注率。
研究设计：回顾性队列研究。
方法：本研究在一家三级大学医院的新生儿重症监护病房进行。分析了 2013 年 1 月至 2016 年 7 月期间在新生儿重症监护病房住院且血小板计数<150×10/L 的新生儿的病历。
结果：在研究期间，共有 2667 名患者入住新生儿重症监护病房，其中 395 名（14%）在住院期间发生血小板减少症。颅内出血的发生率为 7.3%。多变量逻辑回归分析显示，尽管较低的血小板计数与颅内出血发生率较高有关，但呼吸窘迫综合征、败血症和动脉导管未闭的影响比血小板减少症的严重程度更为显著。30 名（7%）患者接受了血小板输注，与未输注血小板的患者相比，这些患者的死亡率显著更高（p<0.001）。此外，我们发现，在我们的患者中使用血小板质量指数为基础的标准进行血小板输注可以将血小板输注率降低 9.5%（2/21）。
结论：新生儿血小板减少症通常较轻，往往不经治疗即可自行缓解。由于血小板输注与死亡率增加有关，因此应仔细权衡其风险和益处。使用血小板质量指数为基础的标准可能会降低新生儿重症监护病房的血小板输注率，但需要来自前瞻性研究的更多数据。
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