Thrombocytopenia related neonatal outcome in preterms
Thrombocytopenia related neonatal outcome in preterms
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DOI：
10.1007/s12098-007-0042-x
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发表时间：
2007-03-01
影响因子：
4.3
通讯作者：
Mehta, Rajeev
中科院分区：
文献类型：
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作者：
Bonifacio, Lea;Petrova, Anna;Mehta, Rajeev
Objective.目的探讨极早产儿血小板减少和血小板输注相关的结局。至少发生1次血小板减少症的病例（n=94）从1054例胎龄≥ 100且<150 × 10（9）/L的新生儿数据库中确定血小板计数<150 × 10（9）/L的新生儿（n=70）和对照组（n=70），如果计数>= 50且<100 × 10（9）/L，则为中度，如果血小板计数<50 × 10（9）/L，则为重度），血小板减少症发病年龄（早期< 72 hours and late >= 72小时）。大多数血小板减少症（67.0%）是在72小时后诊断的，其中12.8%为轻度，36.2%为中度，51.0%为重度。重度和中度血小板减少症的新生儿出生时胎龄和出生体重较低。NEC和脓毒症，尤其是念珠菌感染引起的脓毒症，与严重的血小板减少事件相关。IVH的发生与较低的胎龄密切相关，但与血小板减少的严重程度和发病年龄无关。18.4%（7/38）的病例合并皮肤粘膜出血，伴有重度和迟发性血小板减少症。重度血小板减少症输血率为85.4%，中度血小板减少症输血率为64.7%（P < 0.02）。大部分输注血小板的新生儿（49/60，81.7%）胎龄< 28周。胎龄28-32周的输血婴儿与未输血婴儿的平均胎龄和出生体重、严重血小板减少症、IVH、败血症和死亡率相似。胎龄< 28周的血小板输注新生儿出生体重较低，更常发生严重血小板减少，死亡率高于胎龄相似的未输注新生儿。在NICU住院期间，血小板输注并不能降低患有中度和重度血小板减少症的极早产儿的死亡率。
Objective. To investigate the thrombocytopenia and platelet transfusion related outcome in very preterm infants.Methods. Cases (n=94) with at least one episode of thrombocytopenia ( platelet counts < 150X10(9)/L) and controls (n=70) were identified from a database of 1054 neonates with gestational age = 100 and < 150X10(9)/L, moderate if count >= 50 and < 100X10(9)/L, and severe if platelets < 50X10(9)/L), age of thrombocytopenia onset ( early < 72 hours and late >= 72 hours).Results. The majority of thrombocytopenia (67.0%) was diagnosed after 72 hours of age, and was mild in 12.8%, moderate in 36.2% and severe in 51.0% of the cases. Neonates with severe and moderate thrombocytopenia were more frequently born at lower gestational age and birth weight. NEC and sepsis especially that caused by Candida infection, were associated with severe thrombocytopenic events. The development of IVH was strongly associated with lower gestational age but not the severity and age of thrombocytopenia onset. Mucocutaneous bleeding complicated 18.4% of cases with severe and late-onset thrombocytopenia (7/38). Platelets were transfused to 85.4% of infants with severe and 64.7% of infants with moderate thrombocytopenia (P < 0.02). The gestational age of the majority of the platelet transfused neonates (49/60, 81.7%) was < 28 weeks. Mean gestational age and birth weight, and rates of severe thrombocytopenia, IVH, sepsis and mortality were comparable in transfused vs not-transfused infants with gestational age 28-32 weeks. Platelet transfused neonates with gestational age < 28 weeks had lower birth weights, were more often severely thrombocytopenic, and died more frequently than infants of a similar gestational age who were not transfused.Conclusion. Platelet transfusions did not lower mortality in very premature born infants with moderate and severe thrombocytopenia during the NICU admission.