| ObjectiveBy analyzing the clinical characteristics,etiology and risk factors of neonatal thrombocytopenia,the prevalence,etiology and prognosis of the neonatal thrombocytopenia were explored,and the early clinical diagnosis of the causes were identified,thus targeted therapy to reduce the complications.MethodsRetrospective analysis of thrombocytopenia in neonates admitted to the neonatal intensive care unit of a general hospital in Henan Province from December 2017 to November 2018.Those with twice or more thrombocytopenia were counted by using the first episode data.General clinical datas such as gender,gestational age,Apgar score,birth weight,mode of delivery,amniotic fluid,placenta,umbilical cord,maternal pregnancy and thrombocytopenia during pregnancy were collected,including time of onset,platelet count for first thrombocytopenia,minimum platelet count,duration of thrombocytopenia,bleeding events,etiology,treatment and prognosis.Comparative analysis of general clinical data(sex,gestational age,birth weight,delivery mode)of neonates with normal platelet count and thrombocytopenia in the same period;Etiology analysis of early-onset and late-onset thrombocytopenia;Etiology analysis of premature infants and full-term thrombocytopenia;Analysis of factors affecting the degree of thrombocytopenia;Relationship between the degree of thrombocytopenia and bleeding events;Prognosis analysis;Single factor analysis and multivariate analysis of risk factors for death.Statistical analysis was performed using SPSS 21.0.The quantitative datas of the normal distribution of the data were expressed as mean ± standard deviation(?x ± s),and the non-normal distribution of quantitative data were determined by median(M)and the interquartile range(IQR);The qualitative datas were expressed as percentage;The quantitative datas were compared by t test or analysis of variance,and the qualitative datas were compared by Chi-square test and multivariate logistic regression analysis;the test level was all equal to 0.05,p<0.05 was considered statistically significant.Results1.There were 2927 neonates admitted to neonatal intensive care unit during the study time.Of the 2927 neonates,342 had thrombocytopenia,so the prevalence of neonatal thrombocytopenia was 11.7%.Of the 342 cases of thrombocytopenic,There were 206 males(60.2%)and 136 females(39.8%)with a male to female ratio of 1.51:1.There were 264(77.2%)in the premature infant group and 78(22.8%)in the full-term infant group and median gestational age was 32 weeks(IQR 30-36w).There were 275(80.4%)with birth weight <2500g,67(19.6%)with birth weight ?2500g,and median birth weight of 1400g(IQR 1100~2055g).53(15.5%)were delivered vaginally and 289(84.5%)were delivered by cesarean section.There was no significant difference in the incidence of neonatal thrombocytopenia between genders(P>0.05),but the incidence of neonatal thrombocytopenia was statistically significant between gestational age,birth weight and mode of delivery(P<0.05).2.There were 137(40.1%)with early onset thrombocytopenia,and the most common causes were sepsis 31.4%(43/137),followed by placental insufficiency 20.4%(28/137)and immune factors 14.6%(20/137).205(59.9%)had late-onset thrombocytopenia.The most common causes were sepsis(51.2%(105/205),followed by neonatal pneumonia 10.2%(21/205),neonatal necrotizing enterocolitis(NEC)9.3%(19/205).The most common causes of thrombocytopenia in <34 weeks gestation of preterm infants were sepsis 53.4%(118/221),followed by placental insufficiency 13.1%(29/221),NEC 8.6%(19/221);the most common causes of thrombocytopenia in late preterm infants were sepsis 23.3%(10/43),followed by immune factors 20.9%(9/43),placental insufficiency 18.6%(8/43);full-term thrombocytopenia were sepsis 25.6%(20/78),followed by immune factors 16.7%(13/78)and peripheral arteriovenous exchange11.5%(9/78).3.In this study,276(80.7%)had mild thrombocytopenia and 66(19.3%)had severe thrombocytopenia.By analyzing the influence of different causes on the degree of thrombocytopenia,immunological factors,NEC and K-M syndrome in mild and severe thrombocytopenia were statistically significant(P<0.05);There was no significant significant in the incidence of mild and severe thrombocytopenia between other causes(P>0.05).There were 180 cases of bleeding events in this study,accounting for 52.6%(180/342),including mild bleeding events 71.7%(129/180),and severe bleeding events 28.3%(51/180),and there was statistically significant differences in bleeding events between mild and severe thrombocytopenia(P<0.05).4.In this study,neonates were targeted therapy when the causes were identified,302(88.4%)were cured,and 40(11.6%)died.The most common causes of death were sepsis 40%(16/40),followed by NEC 20%(8/40),neonatal asphyxia 12.5%(5/40),and severe pneumonia 5%(2/40).5.There was no statistically significant sex and sepsis between the death group and the cure group(P>0.05).There was statistically significant gestational age,birth weight,time of onset,bleeding event,degree of thrombocytopenia,platelet transfusion,NEC between the death group and the cure group(P<0.05).Multivariate logistic regression analysis showed gestational age<34 weeks(OR 1.366,95%CI 1.031~1.809),severe thrombocytopenia(OR 2.971,95%CI 1.329~6.641),mild bleeding events(OR 5.780,95%CI 2.245~14.884),severe bleeding events(OR 16.011,95%CI 5.020~51.059),NEC(OR 4.549,95%CI 1.356~15.260)were statistically significant risk factors for mortality(P<0.05).Conclusion1.The prevalence of neonatal thrombocytopenia was 11.7% in the study.Preterm infants,low birth weight infants,and neonatals who delivered by cesarean section were more likely to develop thrombocytopenia than full-term infants,normal birth weight infants,and vaginal delivery.2.The most common causes of early-onset thrombocytopenia were sepsis followed by placental insufficiency and immune factors.However,the most common causes of late-onset thrombocytopenia were sepsis,followed by neonatal pneumonia and NEC.Excluding infection factors,<34 weeks gestation of NT should consider placental insufficiency,and those of ? 34 weeks gestation should consider immune factors.3.The degree of thrombocytopenia have an impact on the occurrence of bleeding events.4.In this study,the mortality of neonates with NT was 11.6%.The most common causes of death were sepsis,followed by NEC.Gestational age <34 weeks,severe thrombocytopenia,bleeding events,NEC were independent risk factors for death in neonates with NT. |
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