In:
Pediatrics, American Academy of Pediatrics (AAP), Vol. 136, No. 2 ( 2015-08-01), p. e361-e370
Abstract:
Thrombocytopenia is common among small-for-gestational-age (SGA) neonates (birth weight & lt;10th percentile reference range), but several aspects of this thrombocytopenia are unclear, including the incidence, typical nadir, duration, association with preeclampsia, mechanism, and risk of death. METHODS: Using 9 years of multihospital records, we studied SGA neonates with ≥2 platelet counts & lt;150 000/μL in their first week. RESULTS: We found first-week thrombocytopenia in 31% (905 of 2891) of SGA neonates versus 10% of non-SGA matched controls (P & lt; .0001). Of the 905, 102 had a recognized cause of thrombocytopenia (disseminated intravascular coagulation, early-onset sepsis, or extracorporeal membrane oxygenation). This group had a 65% mortality rate. The remaining 803 did not have an obvious cause for their thrombocytopenia, and we called this “thrombocytopenia of SGA.” They had a mortality rate of 2% (P & lt; .0001) and a mean nadir count on day 4 of 93 000/μL (SD 51 580/μL, 10th percentile 50 000/μL, 90th percentile 175 000/μL). By day 14, platelet counts were ≥150 000/μL in more than half of the patients. Severely SGA neonates ( & lt;1st percentile) had lower counts and longer thrombocytopenia duration (P & lt; .001). High nucleated red cell counts at birth correlated with low platelets (P & lt; .0001). Platelet transfusions were given to 23%, and counts typically more than tripled. Thrombocytopenia was more associated with SGA status than with the diagnosis of maternal preeclampsia. CONCLUSIONS: SGA neonates with clearly recognized varieties of thrombocytopenia have a high mortality rate. In contrast, thrombocytopenia of SGA is a hyporegenerative condition of moderate severity and 2 weeks’ duration and is associated with evidence of intrauterine hypoxia and a low mortality rate.
Type of Medium:
Online Resource
ISSN:
0031-4005
,
1098-4275
DOI:
10.1542/peds.2014-4182
Language:
English
Publisher:
American Academy of Pediatrics (AAP)
Publication Date:
2015
detail.hit.zdb_id:
1477004-0
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