van der Staaij Hilde, Hooiveld Nadine M A, Caram-Deelder Camila, Fustolo-Gunnink Suzanne F, Fijnvandraat Karin, Steggerda Sylke J, de Vries Linda S, van der Bom Johanna G, Lopriore Enrico
Department of Paediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
Arch Dis Child Fetal Neonatal Ed. 2025 Feb 21;110(2):122-127. doi: 10.1136/archdischild-2024-326959.
To describe the incidence of major bleeds according to different platelet counts in very preterm infants, and to explore whether this association is influenced by other risk factors for bleeding.
Observational cohort study.
A Dutch tertiary care neonatal intensive care unit.
All consecutive infants with a gestational age at birth <32 weeks admitted between January 2004 and July 2022.
Infants were stratified into nine groups based on their nadir platelet count (×10/L) during admission (<10, 10-24, 25-49, 50-99, 100-149, 150-199, 200-249, 250-299 and ≥300), measured before the diagnosis of a major bleed and before any platelet transfusion was administered.
Incidence of major bleeds during admission. Logistic regression analysis was used to quantify the relationship between nadir platelet count and incidence of major bleeds.
Among 2772 included infants, 224 (8%) developed a major bleed. Of the infants with a major bleed, 92% (206/224) had a nadir platelet count ≥50×10/L. The incidence of major bleeds was 8% among infants with and without severe thrombocytopenia (platelet count <50×10/L), 18/231 (95% CI 5 to 12) and 206/2541 (95% CI 7 to 9), respectively. Similarly, after adjustment for measured confounders, there was no notable association between nadir platelet counts below versus above 50×10/L and the occurrence of major bleeds (OR 1.09, 95% CI 0.61 to 1.94).
In very preterm infants, the vast majority of major bleeds occur in infants without severe thrombocytopenia.
描述极早产儿中不同血小板计数时严重出血的发生率，并探讨这种关联是否受其他出血危险因素的影响。
观察性队列研究。
荷兰一家三级医疗新生儿重症监护病房。
2004年1月至2022年7月期间收治的所有出生胎龄<32周的连续婴儿。
根据入院期间最低血小板计数（×10/L）将婴儿分为九组（<10、10 - 24、25 - 49、50 - 99、100 - 149、150 - 199、200 - 249、250 - 299和≥300），在诊断严重出血之前且在输注任何血小板之前进行测量。
入院期间严重出血的发生率。采用逻辑回归分析量化最低血小板计数与严重出血发生率之间的关系。
在纳入的2772例婴儿中，224例（8%）发生了严重出血。在发生严重出血的婴儿中，92%（206/224）的最低血小板计数≥50×10/L。血小板计数<50×10/L（严重血小板减少）和≥50×10/L的婴儿中严重出血的发生率分别为8%，分别为18/231（95%CI 5至12）和206/2541（95%CI 7至9）。同样，在对测量的混杂因素进行调整后，最低血小板计数低于与高于50×10/L与严重出血的发生之间没有显著关联（OR 1.09，95%CI 0.61至1.94）。
在极早产儿中，绝大多数严重出血发生在无严重血小板减少的婴儿中。
