Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors

PLoS One. 2017 Oct 4;12(10):e0185581. doi: 10.1371/journal.pone.0185581. eCollection 2017.

Abstract

Objectives: Thrombocytopenia is a frequent problem in neonatal sepsis and is among the most predictive, independent risk factors for sepsis-associated mortality. This study aims to clarify the occurrence, severity and duration of thrombocytopenia in neonatal sepsis.

Study design: A cohort study was carried out among all neonates with proven culture positive sepsis that were admitted to a tertiary NICU between 2006 and 2015 (n = 460). The occurrence, severity and duration of thrombocytopenia were recorded, as well as major bleedings and potential risk factors for mortality in neonatal sepsis.

Results: Sepsis was diagnosed in 460 of 6551 neonates (7%). Severe thrombocytopenia (platelets ≤50*109/L) occurred in 20% (92/460) of septic neonates. The median time for platelets to rise >100*109 was 6.0 days (interquartile range 4.0-7.0). On multivariate analysis, maternal hypertension, intravascular thrombosis and Gram negative (as opposed to Gram positive) sepsis were independently associated with thrombocytopenia in neonatal sepsis. In severe thrombocytopenia, 10% (9/92) suffered a severe IVH, compared to 5% (20/356) in neonates with platelets >50*109/L (p = 0.125). 10% (9/92) suffered a pulmonary hemorrhage, compared to 2% (9/368) in neonates with platelets >50*109/L (p = 0.001). On multivariate analysis, thrombocytopenia and Gram negative (as opposed to Gram positive) sepsis were independently associated with neonatal mortality.

Conclusions: Thrombocytopenia is independently associated with maternal hypertension, intravascular thrombosis and Gram negative sepsis. Thrombocytopenia in neonatal sepsis increases the risk of mortality nearly four-fold, with another six-fold increase in mortality in case of Gram negative sepsis.

MeSH terms

  • Cohort Studies
  • Female
  • Humans
  • Incidence
  • Infant, Newborn
  • Infant, Newborn, Diseases / epidemiology*
  • Male
  • Risk Factors
  • Sepsis / complications*
  • Sepsis / epidemiology
  • Severity of Illness Index
  • Thrombocytopenia / complications*
  • Thrombocytopenia / epidemiology

Grant support

The authors received no specific funding for this work.