Early Fall in Platelet Count: A True Reminder of Outcomes in Preterm Neonates

Poornima Prakash Kulkarni, Ashwini Sankannavar, Manasa BM

Abstract

Background and Aim: Thrombocytopenia is an independent risk factor of morbidity and mortality among preterm neonates. Severe thrombocytopenia is usually of acquired varieties and results from consumptive thrombocytopenia. The objective of our study was to determine the incidence of > 30% fall in platelet count in preterm neonates and to assess the mortality rate and length of hospital stay (LOS) among the survivors.

Materials and Methods: This was a prospective observational study conducted in a tertiary care NICU. All preterm neonates admitted on day 1 of life to the NICU were considered for the study. The platelet count determined on day 1 was taken as the baseline value. Subsequently, platelet counts were determined twice before the end of week 1. The neonates were classified into 4 groups based on the level of fall in the platelet count. Group 1 neonates had normal platelet counts with no platelet decline, group 2 neonates had normal platelet count with > 30% decline in platelet count from baseline, group 3 neonates had thrombocytopenia with no platelet decline, and group 4 neonates had thrombocytopenia with > 30% decline in platelets from baseline.

Results: A total of 130 preterm neonates were included in this study, of whom 16.92% (n = 22) stayed in the hospital for > 30 days. Most of these neonates belong to group 4, followed by group 2. Among these neonates, 8.46% (n = 11) had gram-positive bacterial infection, 3.85% (n = 5) had gram-negative bacterial infection, and 32.31% (n = 42) had fungal infection. The overall mortality was 19.23% (n = 25), and the highest mortality was noted in group 4.

Conclusion: A fall in platelet count in the first 7 days of life is an early predictor of mortality, LOS, and sepsis.