Sepsis, genetic mutations and perinatal asphyxia are the most common causes of severe neonatal thrombocytopenia in China, according to a retrospective cohort study currently under review at BMC Pediatrics.
Severe neonatal thrombocytopenia is a rare and potentially life-threatening disease characterized by platelet levels at or below 50,000 per microliter. This disease has many potential causes. In fetal and neonatal alloimmune thrombocytopenia (FNAIT), for example, the disease results when a pregnant individual’s immune system attacks the baby’s platelets.
Few studies on severe neonatal thrombocytopenia have been conducted in China. Therefore, in this retrospective cohort study, Shan et al. sought to characterize the causes of the disease and prognosis of infants admitted to the neonatal intensive care unit (NICU) at Fudan University, China between October 2016 and February 2021.
Disease etiologies
The authors included 194 infants with severe thrombocytopenia, accounting for 3.3% of all newborns admitted to the NICU during the study period. Newborns were classified as having early-onset disease if they were diagnosed within the first 72 hours of life. Additionally, infants with platelet levels at or below 30,000 per microliter were categorized as having very severe thrombocytopenia.
Read more about FNAIT causes and risk factors
Of the 190 patients for whom data on the cause of their thrombocytopenia was available, sepsis was the most common cause, with about 22 cases of early-onset and 30 cases of late-onset sepsis. Genetic mutations and asphyxia were the second and third most common causes, respectively.
FNAIT caused severe thrombocytopenia in 12 patients, accounting for 6.2% of total cases in this study. The authors also identified a variety of other causes, including cytomegalovirus infection and necrotizing enterocolitis.
Patient outcomes
In addition, the authors evaluated clinical manifestations of the disease and outcomes among the patients. They observed an overall hemorrhaging risk of 61.9%, with patients with very severe thrombocytopenia having a higher risk than those with severe thrombocytopenia.
Among all patients, the mortality rate was 26.8%. The majority of deaths occurred in individuals whose disease was caused by sepsis, asphyxia and necrotizing enterocolitis. Those with early-onset severe thrombocytopenia had a lower mortality rate than those with late-onset disease.
“Further research is needed to improve the accuracy and accessibility of diagnostic tests, such as [trio whole exome sequencing], bone marrow aspiration and blood culture, in order to achieve accurate and timely diagnoses and improve outcomes,” the authors advised.
