From the Guidelines
Neonatal thrombocytopenia should be managed based on the severity, cause, and presence of bleeding, with a focus on minimizing the risk of hemorrhage and improving outcomes. The management of neonatal thrombocytopenia depends on various factors, including the underlying cause, the severity of the thrombocytopenia, and the presence of bleeding.
Causes and Diagnosis
Some key causes of neonatal thrombocytopenia include:
- Decreased production due to congenital disorders or viral infections
- Increased destruction, which can be immune-mediated or due to consumption
- Sequestration, as seen in hypersplenism According to 1, fetal or neonatal platelet count cannot be reliably predicted by maternal platelet count, platelet antibody levels, or history of maternal splenectomy for ITP.
Management Strategies
For mild to moderate thrombocytopenia (50,000-150,000/μL) without bleeding, observation is typically sufficient. However, for severe thrombocytopenia (<50,000/μL) or any thrombocytopenia with active bleeding, platelet transfusion is recommended at 10-15 mL/kg of platelet concentrate, as guided by the clinical scenario and institutional protocols. In cases of immune-mediated thrombocytopenia, such as neonatal alloimmune thrombocytopenia (NAIT), intravenous immunoglobulin (IVIG) at 1 g/kg daily for 1-2 days may be given. For NAIT, antigen-negative platelets (typically maternal platelets) are preferred when available.
Monitoring and Treatment
Regular monitoring of platelet counts is essential, typically every 12-24 hours in severe cases. The underlying cause should be investigated and treated, which may include:
- Antibiotics for sepsis
- Discontinuation of implicated medications
- Management of underlying conditions As noted in 1, FNAIT should be considered in an index pregnancy with fetal ICH that occurs in the absence of any apparent final cause, including anatomical defects or prematurity. Intramuscular injections, such as vitamin K, should be avoided until the platelet count is known, and transcranial ultrasonography should be performed on neonates with platelet counts less than 50 × 10^9/L at delivery, as recommended by 1. By prioritizing the management of neonatal thrombocytopenia based on the severity, cause, and presence of bleeding, healthcare providers can minimize the risk of hemorrhage and improve outcomes for affected newborns.
From the Research
Definition and Prevalence of Neonatal Thrombocytopenia
- Neonatal thrombocytopenia is defined as a platelet count below 100 x 10^9/L 2 or <150 × 10^9/L 3
- It is a common finding in the neonatal period, especially in critically ill infants and preterm newborns 2
- Thrombocytopenia is the most common haematological abnormality in newborns admitted to neonatal care units 4
Causes of Neonatal Thrombocytopenia
- The causes of thrombocytopenia are multiple and can be due to pediatric conditions or factors involved in the fetal-placental-maternal interface 2
- Thrombocytopenia can be caused by intrauterine growth restriction, sepsis, necrotizing enterocolitis (NEC), and other conditions 3, 5
- Two subgroups of thrombocytopenia can be distinguished: early thrombocytopenia (within the first 72 hours of life) and late thrombocytopenia (after the first 72 hours of life) 5
Diagnosis and Management of Neonatal Thrombocytopenia
- Distinguishing the causes of thrombocytopenia is critical for accurate diagnosis and management 3
- Platelet transfusions are the hallmark of treatment, but their efficacy in preventing bleeding has never been proven 5
- The use of platelet transfusions should be judicious and restrictive, especially in preterm neonates 3, 5
- An appropriate work-up is essential to guide therapy and avoid severe bleeding 4
Treatment Approaches
- Treatment approaches vary depending on the cause and severity of thrombocytopenia 2, 3
- Platelet transfusions are often used, but the risks and benefits should be carefully considered 3, 5
- Recent advances in genomic technology and clinical trials of platelet transfusion practice are changing the landscape of diagnosis and management 3