From the Guidelines
Thrombocytopenia in newborns should be managed based on severity and underlying cause, with a focus on minimizing invasive procedures and preventing bleeding complications, as recommended by the most recent guidelines 1.
Key Considerations
- A platelet count below 150,000/μL defines thrombocytopenia, with severe cases below 50,000/μL warranting immediate intervention.
- The most common causes include maternal immune thrombocytopenia (ITP), neonatal alloimmune thrombocytopenia (NAIT), infections, and congenital disorders.
- Initial management involves close monitoring of platelet counts and assessment for bleeding.
Management Strategies
- For severe thrombocytopenia with active bleeding, platelet transfusions at 10-15 mL/kg are indicated, as supported by the American Society of Hematology 2019 guidelines 1.
- In NAIT, intravenous immunoglobulin (IVIG) at 1 g/kg daily for 1-2 days is the first-line treatment, while maternal ITP may require IVIG and sometimes corticosteroids.
- Avoid invasive procedures when possible in thrombocytopenic newborns, and if necessary, transfuse platelets prophylactically for counts below 30,000/μL, as recommended by the international consensus report on the investigation and management of primary immune thrombocytopenia 1.
Monitoring and Prognosis
- Serial cranial ultrasounds are recommended to detect intracranial hemorrhage in severe cases.
- The prognosis depends on the underlying cause, with immune-mediated cases typically resolving within weeks, while congenital forms may require long-term management.
- Early hematology consultation is essential for optimal outcomes, especially in severe or persistent cases, as emphasized by the American Society of Hematology 2019 guidelines 1.
From the Research
Definition and Prevalence of Thrombocytopenia in Newborns
- Thrombocytopenia is defined as a platelet count below 100 x 10^9/L and is a common finding in the neonatal period, especially in critically ill infants and preterm newborns 2.
- It is estimated that roughly one-quarter of all NICU patients and half of all sick preterm neonates develop thrombocytopenia 3.
Causes of Thrombocytopenia in Newborns
- Thrombocytopenia in newborns can be caused by various factors, including placental insufficiency, sepsis, necrotizing enterocolitis, and immune thrombocytopenia 4, 2, 5, 3.
- Early-onset thrombocytopenia (<72 hours) is most commonly associated with fetomaternal conditions complicated by placental insufficiency and/or fetal hypoxia, while late-onset thrombocytopenia (>72 hours) is almost always associated with sepsis or necrotizing enterocolitis 5, 3.
Management and Treatment of Thrombocytopenia in Newborns
- Platelet transfusion remains the only treatment for thrombocytopenia in newborns, but there is a need for trials to define the safe lower limit for platelet count and which neonates will benefit from treatment 4, 5, 3.
- The use of recombinant haemopoietic growth factors, such as thrombopoietin and interleukin-11, may be a useful future therapy to ameliorate neonatal thrombocytopenia 3.
- For immune thrombocytopenia, newer treatments such as thrombopoietin receptor agonists have transformed care, with high efficacy and improved quality of life for patients 6.