The following is the summary of “Bleeding in neonates with severe thrombocytopenia: a retrospective cohort study” published in the December 2022 issue of Pediatrics by Peng, et al.

A number of different conditions can cause extremely low platelet counts in newborns. Clinicians have focused a lot of emphasis on severe thrombocytopenia with bleeding because of how dangerous it is. However, the correlation between severe thrombocytopenia and bleeding has only been the subject of several investigations. Therefore, the goals of this study were to describe the clinical characteristics, bleeding patterns, and outcomes of neonates with severe thrombocytopenia; evaluate the association between minimum platelet count and bleeding; and describe the postnatal age at which severe thrombocytopenia was first recognized.

Neonates with severe thrombocytopenia (platelet count  ≤ 50×109L) were the focus of retrospective cohort research. Infants with severe thrombocytopenia admitted to their newborn intensive care unit between October 2016 and February 2021 were studied. Information was gathered after patients had already been transferred to other facilities, released, or passed away. Only 170 of the 5,819 neonatal inpatients were found to have severe thrombocytopenia. In the first three days of life, severe thrombocytopenia affected more than 30% of the patients. About 47 of the 118 newborns diagnosed with hemorrhage had bleeding from more than one pathology. The incidence of cutaneous bleeding was higher in neonates with very severe thrombocytopenia (point estimate: 53.7%, 95% CI: 44.2%-63.1%) than in those with severe thrombocytopenia (point estimate: 23.4%, 95% CI: 12.3%-34.4%). Compared to the groups with no bleeding, minor bleeding, and significant bleeding, the major bleeding group had the earliest median gestational age (36.2 [interquartile range] IQR: 31.4-39.0] weeks) and the lowest birth weight (2,310 [IQR: 1213-3210] g). 

In a multivariate analysis, controlling for potential confounding factors, the association between a low platelet count and an elevated bleeding rate was verified (odds ratio [OR]: 2.504 [95% CI: 1.180-5.314], P=0.017). Platelet transfusions were more common in patients with severe thrombocytopenia (point estimate: 49.1%, 95% CI: 39.6%-58.6%) than those with severe thrombocytopenia (point estimate: 5.7%, 95% CI: 0.7%-10.7%). Point estimates with 95% CI showed that the death rate was 33.1% [24.4%-41.7%] for neonates with hemorrhage compared to 7.7% [0.2%-15.2%] for those without bleeding. These results characterize the prevalence of severe thrombocytopenia and show that individuals with a low platelet count have a higher bleeding risk.