Department of Neonatology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
BMC Pediatr. 2022 Dec 22;22(1):730. doi: 10.1186/s12887-022-03802-4.
Severe neonatal thrombocytopenia is a rare disease with multiple etiologies. Severe thrombocytopenia with bleeding is life-threatening and has attracted significant attention from clinicians. However, only a few studies have focused on the association between severe thrombocytopenia and bleeding. Thus, this study aimed to describe the neonates' postnatal age at which severe thrombocytopenia was first recognized, clinical characteristics, bleeding patterns, and outcomes and to evaluate the association between minimum platelet count and bleeding.
A single-center retrospective cohort study for neonates with severe thrombocytopenia (platelet count ≤ 50 × 10/L) was conducted. Neonates who were admitted to our neonatal intensive care unit between October 2016 and February 2021 and developed severe thrombocytopenia were analyzed. Data were collected retrospectively until the patients were referred to other hospitals, discharged, or deceased.
Among the 5819 neonatal inpatients, 170 with severe thrombocytopenia were included in this study. More than 30% of the patients had severe thrombocytopenia in the first 3 days of life. Among the 118 neonates with bleeding, 47 had more than one type of pathological bleeding. Neonates with very severe thrombocytopenia (point estimate: 53.7%, 95% confidence interval [CI]: 44.2%-63.1%) had a higher incidence rate of cutaneous bleeding than those with severe thrombocytopenia (point estimate: 23.4%, 95% CI: 12.3%-34.4%). The gestational age (median: 36.2 [interquartile range [IQR]: 31.4-39.0] weeks) and birth weight (median: 2310 [IQR: 1213-3210] g) of the major bleeding group were the lowest among no bleeding, minor bleeding, and major bleeding groups. Regression analysis controlled for confounders and confirmed that a lower platelet count (odds ratio [OR]: 2.504 [95% CI: 1.180-5.314], P = 0.017) was associated with a significant increase in the rate of bleeding. Very severe thrombocytopenia (point estimate: 49.1%, 95% CI: 39.6%-58.6%) had a higher rate of platelet transfusion than severe thrombocytopenia (point estimate: 5.7%, 95% CI: 0.7%-10.7%). The mortality rate was higher in neonates with bleeding than in those without bleeding (point estimates with 95% CI: 33.1% [24.4%-41.7%] vs. 7.7% [0.2%-15.2%]).
These findings describe the incidence of severe thrombocytopenia and demonstrate that a lower platelet count is associated with an increased bleeding rate in patients with severe thrombocytopenia.
严重新生儿血小板减少症是一种病因多样的罕见疾病。伴有出血的严重血小板减少症危及生命，引起了临床医生的高度关注。然而，只有少数研究关注严重血小板减少症与出血之间的关系。因此，本研究旨在描述新生儿首次出现严重血小板减少症的胎龄、临床特征、出血模式和结局，并评估血小板计数最低值与出血之间的关系。
对 2016 年 10 月至 2021 年 2 月期间我院新生儿重症监护病房收治的严重血小板减少症（血小板计数≤50×10/L）患儿进行单中心回顾性队列研究。收集患儿的临床资料，回顾性分析血小板减少症的发病年龄、临床特征、出血模式及结局，并评估血小板计数最低值与出血的关系。
在 5819 例新生儿住院患者中，纳入本研究的严重血小板减少症患儿共 170 例。超过 30%的患儿在出生后第 3 天内出现严重血小板减少症。在 118 例有出血的患儿中，47 例有多种类型的病理性出血。极重度血小板减少症（点估计值：53.7%，95%置信区间[CI]：44.2%-63.1%）患儿的皮肤出血发生率高于重度血小板减少症患儿（点估计值：23.4%，95%CI：12.3%-34.4%）。无出血、轻度出血和重度出血患儿中，主要出血组的胎龄（中位数：36.2[四分位距[IQR]：31.4-39.0]周）和出生体重（中位数：2310[IQR：1213-3210]g）最低。多因素回归分析校正混杂因素后仍证实，血小板计数较低（比值比[OR]：2.504[95%CI：1.180-5.314]，P=0.017）与出血率增加显著相关。极重度血小板减少症（点估计值：49.1%，95%CI：39.6%-58.6%）患儿的血小板输注率高于重度血小板减少症患儿（点估计值：5.7%，95%CI：0.7%-10.7%）。有出血的患儿死亡率高于无出血的患儿（点估计值及 95%CI：33.1%[24.4%-41.7%]比 7.7%[0.2%-15.2%]）。
本研究描述了严重血小板减少症的发生率，并表明严重血小板减少症患儿的血小板计数越低，出血发生率越高。
