1
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Inam Z, Nickel RS. An infant with severe neonatal immune thrombocytopenia and gradual resumption of breastfeeding. Pediatr Blood Cancer 2024; 71:e30839. [PMID: 38173087 DOI: 10.1002/pbc.30839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Zaina Inam
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert Sheppard Nickel
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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2
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Yasa B, Memur S, Ozturk DY, Bagci O, Uslu SI, Cetinkaya M. Neonatal Outcomes of Premature Infants Born to Women with the Novel Coronavirus (SARS-CoV-2) Infection: A Case Control Study. Am J Perinatol 2023; 40:1715-1724. [PMID: 34839474 DOI: 10.1055/s-0041-1740177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Novel coronavirus disease 2019 (COVID-19) is a disease associated with atypical pneumonia caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). The first cases of COVID-19 were reported in Wuhan at the end of 2019. Transmission usually occurs via infected droplets and close personal contact; the possibility of vertical transmission is still under debate. This retrospective study aimed to analyze clinical characteristics of premature infants born to mothers with symptomatic COVID-19 disease. STUDY DESIGN This case control study compared the clinical and laboratory data of 20 premature infants born to mothers infected with SARS-CoV-2 with sex and gestational age-matched historical controls. RESULTS The median gestational age and birth weight in both groups were similar. Respiratory distress developed in 11 (55.5%) infants in study group and 19 (47.5%) infants in control group. Mechanical ventilation and endotracheal surfactant administration rates were similar. Median duration of hospitalization was 8.5 (2-76) days in study group and 12 days in historical controls. Real-time reverse-transcription polymerase chain reaction tests (RT-PCR) of nasopharyngeal swab samples for SARS-CoV-2 were found to be negative twice, in the first 24 hours and later at 24 to 48 hours of life. No neutropenia or thrombocytopenia was detected in the study group. Patent ductus arteriosus, bronchopulmonary dysplasia, and necrotizing enterocolitis rates were similar between groups. No mortality was observed in both groups. CONCLUSION To the best of our knowledge, this is one of the few studies evaluating the clinical outcomes of premature infants born to SARS-CoV-2 infected mothers. There was no evidence of vertical transmission of SARS-CoV-2 from symptomatic SARS-CoV-2-infected women to the neonate in our cohort. The neonatal outcomes also seem to be favorable with no mortality in preterm infants. KEY POINTS · SARS-CoV-2 pandemic is a challenge for pregnant women.. · Neonatal outcomes of premature infants born to mothers infected with SARS-CoV-2 not well defined.. · SARS-CoV-2 infection seems to have no adverse effect on mortality and morbidity in premature infants..
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Affiliation(s)
- Beril Yasa
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Seyma Memur
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Dilek Y Ozturk
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Onur Bagci
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Sait I Uslu
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Merih Cetinkaya
- Neonatology Department, Istanbul Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
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3
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Berna-Erro A, Granados MP, Rosado JA, Redondo PC. Thrombotic Alterations under Perinatal Hypoxic Conditions: HIF and Other Hypoxic Markers. Int J Mol Sci 2023; 24:14541. [PMID: 37833987 PMCID: PMC10572648 DOI: 10.3390/ijms241914541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/15/2023] Open
Abstract
Hypoxia is considered to be a stressful physiological condition, which may occur during labor and the later stages of pregnancy as a result of, among other reasons, an aged placenta. Therefore, when gestation or labor is prolonged, low oxygen supply to the tissues may last for minutes, and newborns may present breathing problems and may require resuscitation maneuvers. As a result, poor oxygen supply to tissues and to circulating cells may last for longer periods of time, leading to life-threatening conditions. In contrast to the well-known platelet activation that occurs after reperfusion of the tissues due to an ischemia/reperfusion episode, platelet alterations in response to reduced oxygen exposition following labor have been less frequently investigated. Newborns overcome temporal hypoxic conditions by changing their organ functions or by adaptation of the intracellular molecular pathways. In the present review, we aim to analyze the main platelet modifications that appear at the protein level during hypoxia in order to highlight new platelet markers linked to complications arising from temporal hypoxic conditions during labor. Thus, we demonstrate that hypoxia modifies the expression and activity of hypoxic-response proteins (HRPs), including hypoxia-induced factor (HIF-1), endoplasmic reticulum oxidase 1 (Ero1), and carbonic anhydrase (CIX). Finally, we provide updates on research related to the regulation of platelet function due to HRP activation, as well as the role of HRPs in intracellular Ca2+ homeostasis.
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Affiliation(s)
- Alejandro Berna-Erro
- Department of Physiology (Phycell), University of Extremadura, Avd de la Universidad s/n, 10003 Caceres, Spain; (A.B.-E.); (P.C.R.)
| | | | - Juan Antonio Rosado
- Department of Physiology (Phycell), University of Extremadura, Avd de la Universidad s/n, 10003 Caceres, Spain; (A.B.-E.); (P.C.R.)
| | - Pedro Cosme Redondo
- Department of Physiology (Phycell), University of Extremadura, Avd de la Universidad s/n, 10003 Caceres, Spain; (A.B.-E.); (P.C.R.)
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4
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Sousa P, Sousa B, Calheiros-Trigo F, Martins M, Paz-Dias C. Acinetobacter baumannii Early-Onset Sepsis After Home Delivery Into Toilet Water. Cureus 2023; 15:e45951. [PMID: 37885560 PMCID: PMC10599798 DOI: 10.7759/cureus.45951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Early-onset sepsis (EOS) is an important cause of morbidity and mortality in newborns, usually caused by pathogens acquired intrapartum. We present the case of a term neonate born by home delivery in the toilet, after an unsupervised pregnancy. He developed a culture-proven early-onset sepsis caused by Acinetobacter baumannii. This was the first case of neonatal sepsis by this pathogen in our unit. The microorganism was susceptible to all antibiotics tested. The neonate was treated empirically with ampicillin and cefotaxime and completed 21 days of directed therapy with meropenem, as meningitis could not be excluded. During the clinical course, the newborn developed severe and persistent thrombocytopenia and neutropenia. In this report, we discuss the etiology behind this clinical presentation. We intend to raise awareness for the consideration of Acinetobacter baumannii as a potential pathogen in EOS, particularly in the presence of adverse birth circumstances.
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Affiliation(s)
- Patrícia Sousa
- Department of Pediatrics, Hospital Senhora da Oliveira, Guimarães, PRT
| | - Beatriz Sousa
- Department of Neonatology, Hospital Senhora da Oliveira, Guimarães, PRT
| | | | - Mariana Martins
- Department of Neonatology, Hospital Senhora da Oliveira, Guimarães, PRT
| | - Clara Paz-Dias
- Department of Neonatology, Hospital Senhora da Oliveira, Guimarães, PRT
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5
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Weiss LJ, Drayss M, Mott K, Beck S, Unsin D, Just B, Speer CP, Härtel C, Andres O, Schulze H. Ontogenesis of functional platelet subpopulations from preterm and term neonates to adulthood: The PLINIUS study. Blood Adv 2023; 7:4334-4348. [PMID: 37042931 PMCID: PMC10432615 DOI: 10.1182/bloodadvances.2023009824] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/13/2023] Open
Abstract
Erythrocytes undergo a well-defined switch from fetal to postnatal circulation, which is mainly reflected by the stage-specific expression of hemoglobin chains. Perinatal alterations in thrombopoiesis are poorly understood. We assessed the ontogenesis of platelet phenotype and function from early prematurity to adulthood. We recruited 64 subjects comprising 7 extremely preterm (27-31 weeks gestational age), 25 moderately preterm (32-36 weeks), 10 term neonates, 8 infants (<2 years), 5 children (2-13 years), and 9 adults (>13 years). Blood was withdrawn at up to 3 different time points in neonates (t1: 0-2, t2: 3-7, and t3: 8-14 days after birth). We found that the expression levels of the major surface receptors for fibrinogen, collagen, vWF, fibronectin, and laminin were reduced but correlated with decreased platelet size, indicating a normal surface density. Although CD62P and CD63 surface exposure upon stimulation with TRAP-6, ADP, or U46619 was unaltered or only slightly reduced in neonates, GPIIb/IIIa inside-out and outside-in activation was blunted but showed a continuous increase until adulthood, correlating with the expression of the GPIIb/IIIa regulating tetraspanin CD151. Platelet subpopulation analysis using automated clustering revealed that neonates presented with a CD63+/PAC-1- pattern, followed by a continuous increase in CD63+/PAC-1+ platelets until adulthood. Our findings revealed that the number of platelet-monocyte and platelet-neutrophil aggregates, but not platelet-lymphocyte aggregates, is increased in neonates and that neonatal aggregate formation depends in part on CD62P activation. Our PLatelets In Neonatal Infants Study (PLINIUS) provides several lines of evidence that the platelet phenotype and function evolve continuously from neonates to adulthood.
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Affiliation(s)
- Lukas J. Weiss
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Maria Drayss
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Kristina Mott
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
| | - Sarah Beck
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
- University of Würzburg, Rudolf Virchow Center, Würzburg, Germany
| | - David Unsin
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
| | - Bastian Just
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
| | - Christian P. Speer
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Christoph Härtel
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Oliver Andres
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
- University Hospital Würzburg, Center of Inherited Blood Cell Disorders, Würzburg, Germany
| | - Harald Schulze
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
- University Hospital Würzburg, Center of Inherited Blood Cell Disorders, Würzburg, Germany
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6
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Dulmovits BM, Wild KT, Flibotte J, Lambert MP, Kwiatkowski J, Thom CS. Neonatal Thrombocytopenia as a Presenting Finding in de novo Pyruvate Kinase Deficiency. Neonatology 2023; 120:661-665. [PMID: 37473739 PMCID: PMC11027091 DOI: 10.1159/000531242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/22/2023] [Indexed: 07/22/2023]
Abstract
Thrombocytopenia is a common laboratory abnormality encountered in critically ill neonates. The broad differential for thrombocytopenia, and its association with potentially severe neonatal pathology, often presents a diagnostic dilemma prompting extensive evaluation. Hemolysis due to red cell enzymopathies is a rare cause of neonatal thrombocytopenia that is typically brief and self-limiting. Here, we present a case of thrombocytopenia, refractory to transfusion, associated with anemia and hyperbilirubinemia in a neonate with pyruvate kinase deficiency (PKD) arising from compound heterozygous PKLR mutations. The nature of the thrombocytopenia in this patient created considerable diagnostic uncertainty, which was ultimately resolved by whole-exome sequencing. This case emphasizes that inherited red cell defects, such as PKD, are important to consider in cases of neonatal thrombocytopenia.
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MESH Headings
- Infant, Newborn
- Humans
- Thrombocytopenia, Neonatal Alloimmune
- Anemia, Hemolytic, Congenital Nonspherocytic/complications
- Anemia, Hemolytic, Congenital Nonspherocytic/diagnosis
- Anemia, Hemolytic, Congenital Nonspherocytic/genetics
- Pyruvate Metabolism, Inborn Errors/diagnosis
- Pyruvate Metabolism, Inborn Errors/genetics
- Pyruvate Metabolism, Inborn Errors/complications
- Pyruvate Kinase/genetics
- Anemia
- Infant, Newborn, Diseases
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Affiliation(s)
- Brian M Dulmovits
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - K Taylor Wild
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Division of Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - John Flibotte
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michele P Lambert
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Hematology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Janet Kwiatkowski
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Hematology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Christopher S Thom
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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7
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Chandran S, Tergestina M. Trailer Excites, Movie Disappoints. J Obstet Gynaecol India 2023; 73:96-97. [PMID: 36879938 PMCID: PMC9984582 DOI: 10.1007/s13224-021-01616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/27/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Shanu Chandran
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu India
| | - Mintoo Tergestina
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu India
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8
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Joslyn P, Rosenbaum C, Chapple AG, Heard A, Velez M, Barkemeyer B. The effects of maternal hypertension on the early neonatal platelet count. J Perinatol 2022; 42:796-802. [PMID: 34845295 DOI: 10.1038/s41372-021-01278-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the relationship between maternal hypertension and early neonatal platelet counts. STUDY DESIGN This single site retrospective cohort study compared initial platelet counts in the first day of life of infants born to mothers with preeclampsia with severe features (PSF) (n = 224) and infants born to normotensive mothers using multivariable logistic and Quasi-Poisson regression models. RESULT There was no statistical difference in initial platelet counts or likelihood of thrombocytopenia (aOR = 1.19, 95% CI 0.68-2.08) between infants born to mothers with PSF and infants born to normotensive mothers after multivariable adjustment. Initial platelet counts and thrombocytopenia risk were unaffected by the presence of maternal end organ dysfunction. Small for gestational age (SGA) status was the most significant risk factor for the development of thrombocytopenia (aOR = 2.24, 95% CI 1.13-4.30). CONCLUSION Maternal PSF does not directly affect neonatal initial platelet counts. SGA status confers the greatest risk of early thrombocytopenia.
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Affiliation(s)
- Peter Joslyn
- Department of Pediatrics Division of Neonatology, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, USA.
| | - Cornelius Rosenbaum
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, USA
| | - Andrew G Chapple
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, USA
| | - Asha Heard
- Department of Obstetrics and Gynecology Division of Maternal Fetal Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, USA
| | - Maria Velez
- Department of Pediatrics Division of Hematology Oncology, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, USA
| | - Brian Barkemeyer
- Department of Pediatrics Division of Neonatology, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, USA
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9
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Khanuja K, Levy AT, McLaren RA, Berghella V. Pre- and postpregnancy platelet counts: evaluating accuracy of gestational thrombocytopenia and immune thrombocytopenia purpura diagnoses. Am J Obstet Gynecol MFM 2022; 4:100606. [PMID: 35283346 DOI: 10.1016/j.ajogmf.2022.100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/15/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Given the overlapping clinical indicators and lack of diagnostic testing, misdiagnosis of immune thrombocytopenic purpura and gestational thrombocytopenia in pregnancy may be common. Current recommendations suggest utilizing platelet nadir during pregnancy to guide diagnosis. OBJECTIVE This study aimed to assess the accuracy of gestational thrombocytopenia and immune thrombocytopenic purpura diagnoses using pre- and postpregnancy platelet counts. STUDY DESIGN This was a retrospective cohort study of patients diagnosed with gestational thrombocytopenia and immune thrombocytopenic purpura from January 2017 to December 2019. Platelet counts were extracted from charts and evaluated at several time periods, namely prepregnancy (within 5 years), during pregnancy, and postpartum (>6 weeks to 5 years). A diagnosis of gestational thrombocytopenia was considered inaccurate if platelet counts were <150,000/µL pre- or postpregnancy with no other apparent causes or if the platelet nadir dropped below 100,000/µL during pregnancy. A diagnosis of immune thrombocytopenic purpura was deemed inaccurate if pre- or postpregnancy platelet counts were >150,000/µL. The primary outcome was accuracy of gestational thrombocytopenia and immune thrombocytopenic purpura diagnoses in patients. Secondary outcomes included mean platelet counts during pregnancy and difference in mean platelet counts for patients with an accurate vs inaccurate diagnosis of gestational thrombocytopenia. Outcomes were summarized with descriptive statistics and compared using Student t tests. RESULTS A total of 116 patients met the inclusion criteria of which 111 (96%) and 5 (4%) had gestational thrombocytopenia and immune thrombocytopenic purpura diagnoses, respectively. Platelet counts outside of pregnancy were available for 91 (82%) of the patients, and 66 (57%) had prepregnancy platelet counts available. Of the 91 patients, the diagnosis was considered accurate in 61 (67%) and 5 (100%) patients with gestational thrombocytopenia and immune thrombocytopenic purpura, respectively. Conversely, 30 of 35 (86%) patients with immune thrombocytopenic purpura were found to be inaccurately diagnosed with gestational thrombocytopenia after application of platelet thresholds. Among these 30 patients, 10 had a prepregnancy platelet count <150,000/µL, 12 had a postpartum platelet count <150,000/µL, 3 had a platelet count nadir <100,000/µL during pregnancy, and 7 met more than 1 criterion. Pre- and postpregnancy platelet counts and platelet count nadir differed significantly for patients with an accurate vs inaccurate diagnosis of gestational thrombocytopenia (P<.001). CONCLUSION When pre- and postpregnancy platelet counts were checked, one-third of cases of gestational thrombocytopenia met the criteria for immune thrombocytopenic purpura and were thus incorrectly diagnosed during pregnancy. Prepregnancy platelet counts, available for most patients, should be considered when diagnosing gestational thrombocytopenia vs immune thrombocytopenic purpura.
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Affiliation(s)
- Kavisha Khanuja
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA (Dr Khanuja)
| | - Ariel T Levy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medicine at New York Presbyterian Hospital, New York, NY (Dr Levy)
| | - Rodney A McLaren
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA (Drs McLaren and Berghella)
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA (Drs McLaren and Berghella).
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10
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Choi HJ, Kim I, Lee HJ, Oh HJ, Ahn MK, Baek WI, Kim YE, Oh SH, Lee BS, Namgoong JM, Kim DY, Lee EJ, Shim JO, Ko JS, Kim KM. Clinical characteristics of neonatal cholestasis in a tertiary hospital and the development of a novel prediction model for mortality. EBioMedicine 2022; 77:103890. [PMID: 35220043 PMCID: PMC8889106 DOI: 10.1016/j.ebiom.2022.103890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/24/2021] [Accepted: 02/04/2022] [Indexed: 11/05/2022] Open
Abstract
Background Few studies have described the aetiologies of neonatal cholestasis, and the overall neonatal cholestasis-related mortality (NCM) rate is unclear. We investigated the aetiology and outcome of neonatal cholestasis in a tertiary hospital and developed an NCM prediction model for these patients. Methods Patients aged <100 days with serum direct bilirubin (DB) levels of >1.0 mg/dL were retrospectively screened. Diagnostic and laboratory data during the 8-week follow-up period after enrolment between 2005 and 2020 were extracted digitally, and medical charts were reviewed manually by clinicians. Logistic regression was used to derive a prediction model for the 1-year mortality outcome of neonatal cholestasis, and performance evaluation and external validation were conducted for the NCM prediction model. Findings We enrolled 4028 neonates with DB of >1.0 mg/dL at least once. Prematurity and birth injury (35.4%), complex heart anomalies (18.6%), liver diseases (11.4%), and gastrointestinal anomalies (9.2%) were the most common aetiologies; 398 (9.9%) patients died before one year of age. The peak value of DB was positively correlated to the 1-year mortality rate. In the multivariate analysis, simple laboratory indices, including platelet, prothrombin time, aspartate aminotransferase, albumin, direct bilirubin, creatinine, and C-reactive protein, were independent predictors of 1-year mortality outcome of complete-case subjects. Using these laboratory indices, a logistic regression-based NCM prediction model was constructed. It showed acceptable performances on discrimination (area under the curve, 0.916), calibration (slope, 1.04) and Brier scoring (0.072). The external validation of the sample (n = 920) from two other centres also revealed similar performance profiles of the NCM model. Interpretation Various aetiologies of neonatal cholestasis were identified in a tertiary hospital, resulting in unfavourable outcomes of a large proportion. The NCM prediction model may have the potential to help clinicians to be aware of high-risk neonatal cholestasis.
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11
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Carter R, Niemi AK. Severe thrombocytopenia and intracranial hemorrhage in a newborn with Noonan syndrome and neonatal alloimmune thrombocytopenia. Platelets 2021; 33:649-651. [PMID: 34904514 DOI: 10.1080/09537104.2021.1981845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Noonan syndrome (NS) is a genetic disorder with distinctive physical features and often multiple organ involvement. Bleeding disorders are reported in over half of patients with NS, including thrombocytopenia and platelet dysfunction. Neonatal alloimmune thrombocytopenia (NAIT) is an alloantigenic thrombocytopenia that can present with severe bleeding. Here, we present a case of intracranial hemorrhage and severe thrombocytopenia in a neonate found to have both NAIT and a de novo heterozygous pathogenic variant in PTPN11, consistent with Noonan syndrome.
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Affiliation(s)
- Rebecca Carter
- Division of Neonatology, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Anna-Kaisa Niemi
- Division of Neonatology, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Division of Neonatology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA, USA
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12
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Nassir KF, Al-Saddi YI, Abbas HM, Al Khames Aga QA, Al Khames Aga LA, Oudah AA. Pentaglobin (immunoglobulin M-enriched immunoglobulin) as adjuvant therapy for premature and very low-birth-weight neonates with sepsis. Indian J Pharmacol 2021; 53:364-370. [PMID: 34854404 PMCID: PMC8641746 DOI: 10.4103/ijp.ijp_881_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES: The purpose of this research was to determine the effectiveness of Pentaglobin® as adjuvant therapy in the treatment of sepsis in preterm newborns. MATERIALS AND METHODS: It was a prospective, observational, randomized study for 272 premature neonates and very low birth weight (VLBW) that were diagnosed with sepsis carried at neonatal intensive care units. The patients randomized into control group who received standard sepsis antibiotic treatments, and an intervention group who received Pentaglobin® 5 ml/kg daily for 3 consecutive days as an adjunct therapy to a standard sepsis antibiotic treatment. RESULTS: Multiple organisms that isolated from culture specimens were Gram-negative bacteria, Gram-positive, and candida (56.25%, 42.28%, and 1.47%, respectively). The disease duration was distinctively longer in patients who were treated by the standard antibiotic protocol (mean ± standard deviation [SD]: 30.76 ± 3.97, odds ratio [OR]: 30.76, 95% confidence interval [CI]: 30.051, 31.473) comparing to the patients who received Pentaglobin adjuvant therapy (mean ± SD: 26.48 ± 5.55, OR: 26.48, 95% CI: 25.489, 27.477) (P < 0.000). Patients treated by standard antibiotic protocol were associated to a substantially increased risk of death (11.76%, hazard ratio 4.400, 95% CI: 1.432, 13.529, P = 0.009). CONCLUSION: Neonatal sepsis is more common in premature and VLBW newborns, and Pentaglobin® management of newborn nosocomial sepsis might be used in addition to other therapies.
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Affiliation(s)
- Kawthar F Nassir
- Therapeutic Drug Monitoring Center, Bagdad Teaching Hospital, Mosul, Iraq
| | | | - Hassan M Abbas
- Ministry of Health, Baghdad, Department of Clinical Pharmacy, Mosul, Iraq
| | | | | | - Ameer A Oudah
- Department of Clinical Pharmacy, Bagdad Teaching Hospital, Medical City, Mosul, Iraq
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13
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Beryl S, Ross BJ, Tergestina M, Kumar M. Severe neonatal autoimmune thrombocytopenia secondary to maternal Evans syndrome. BMJ Case Rep 2021; 14:e245695. [PMID: 34857590 PMCID: PMC8640653 DOI: 10.1136/bcr-2021-245695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
Evans syndrome is a rare and chronic autoimmune disease seen in both paediatric and adult age groups. We present a case of severe thrombocytopenia in a neonate born to a mother with Evans syndrome who showed no response to intravenous immunoglobulin therapy initially and improved after treatment with methylprednisolone.
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MESH Headings
- Adult
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/drug therapy
- Child
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Infant, Newborn
- Purpura, Thrombocytopenic, Idiopathic/complications
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/drug therapy
- Thrombocytopenia
- Thrombocytopenia, Neonatal Alloimmune
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Affiliation(s)
- Shafini Beryl
- Department of Neonatology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Benjamin Jeyanth Ross
- Department of Neonatology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Mintoo Tergestina
- Department of Neonatology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Manish Kumar
- Department of Neonatology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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14
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Abebe Gebreselassie H, Getachew H, Tadesse A, Mammo TN, Kiflu W, Temesgen F, Dejene B. Incidence and Risk Factors of Thrombocytopenia in Neonates Admitted with Surgical Disorders to Neonatal Intensive Care Unit of Tikur Anbessa Specialized Hospital: A One-Year Observational Prospective Cohort Study from a Low-Income Country. J Blood Med 2021; 12:691-697. [PMID: 34366682 PMCID: PMC8335549 DOI: 10.2147/jbm.s321757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Thrombocytopenia is one of the most common hematologic disorders affecting neonates admitted to the neonatal intensive care unit. The aim of this study was to determine the incidence and associated risk factors of neonatal thrombocytopenia in neonates admitted with surgical disorders. METHODS An observational prospective cohort study was conducted and all neonates admitted to neonatal intensive care unit of Tikur Anbessa Specialized Hospital with surgical disorders were included. Data were collected using a checklist and analyzed by SPSS version 23. Chi square test and independent sample t- test were used to assess the association among different variables. RESULTS A total of 210 neonates were included in the study, out of which 56.2% were males. The incidence of thrombocytopenia was 55.8%. Among neonates with thrombocytopenia, 90.9% had late onset thrombocytopenia and half were in the severe range (<50,000/µL). The presence of sepsis (P = 0.000) and atresia (P = 0.000) were found to be significantly associated with the development of thrombocytopenia. The mean non feeding hours were found to be significantly longer for patients with thrombocytopenia (t [199], 5.81, P = 0.000). CONCLUSION The incidence of thrombocytopenia is high in our institution. Prevention methods towards neonatal sepsis should be given due emphasis.
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Affiliation(s)
| | - Hanna Getachew
- Addis Ababa University School of Medicine, Department of Surgery, Paediatrics Surgery Unit, Addis Ababa, Ethiopia
| | - Amezene Tadesse
- Addis Ababa University School of Medicine, Department of Surgery, Paediatrics Surgery Unit, Addis Ababa, Ethiopia
| | - Tihitena Negussie Mammo
- Addis Ababa University School of Medicine, Department of Surgery, Paediatrics Surgery Unit, Addis Ababa, Ethiopia
| | - Woubedel Kiflu
- Addis Ababa University School of Medicine, Department of Surgery, Paediatrics Surgery Unit, Addis Ababa, Ethiopia
| | - Fisseha Temesgen
- Addis Ababa University School of Medicine, Department of Surgery, Paediatrics Surgery Unit, Addis Ababa, Ethiopia
| | - Belachew Dejene
- Addis Ababa University School of Medicine, Department of Surgery, Paediatrics Surgery Unit, Addis Ababa, Ethiopia
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15
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Moore CM, Curley AE. Neonatal Platelet Transfusions: Starting Again. Transfus Med Rev 2021; 35:29-35. [PMID: 34312045 DOI: 10.1016/j.tmrv.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
Preterm neonates with severe thrombocytopenia are frequently prescribed prophylactic platelet transfusions despite no evidence of benefit. Neonatal platelet transfusion practice varies, both nationally and internationally. Volumes and rates of transfusion in neonatology are based on historic precedent and lack an evidence base. The etiology of harm from platelet transfusions is poorly understood. Neonates are expected to be the longest surviving recipients of blood produce transfusions, and so avoiding transfusion associated harm is critical in this cohort. This article reviews the evidence for and against platelet transfusion in the neonate and identifies areas of future potential neonatal platelet transfusion research.
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Affiliation(s)
- Carmel Maria Moore
- Department of Neonatology, National Maternity Hospital, Dublin 2, D02YH21, Ireland.
| | - Anna E Curley
- Department of Neonatology, National Maternity Hospital, Dublin 2, D02YH21, Ireland
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16
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Luo H, Li D, Gao F, Hong P, Feng W. A meta-analysis of neonatal outcomes in pregnant women with immune thrombocytopenic purpura. J Obstet Gynaecol Res 2021; 47:2941-2953. [PMID: 34137128 DOI: 10.1111/jog.14890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/10/2021] [Accepted: 06/01/2021] [Indexed: 01/11/2023]
Abstract
AIM Thrombocytopenia is an autoimmune disorder characterized by reduced platelet counts. Neonatal thrombocytopenia incidence has been linked with immune thrombocytopenic purpura in mothers during pregnancy, possibly because antiplatelet antibodies can cross the placental barrier. To date, no study has attempted to evaluate the actual prevalence of neonatal thrombocytopenia in infants born to mothers with immune thrombocytopenic purpura. In this meta-analysis of the available literature, we attempt to fill this gap. We want to evaluate the overall prevalence of neonatal thrombocytopenia, its severity, and the incidence of hemorrhage in infants with thrombocytopenia born from mothers with immune thrombocytopenic purpura. METHODS Adhering to PRISMA guidelines, we systematically scanned four academic databases including EMBASE, CENTRAL, Scopus, and MEDLINE to identify relevant literature. We performed a meta-analysis to summarize thrombocytopenia incidence rate and severity in newborn infants of mothers with immune thrombocytopenic purpura. RESULTS We identified 21 eligible studies involving 1951 mothers and 1844 neonates. Meta-analysis showed high prevalence for neonatal thrombocytopenia (24%). Within these, severe cases were the most prevalent (41.2%), followed by moderate (37.7%) and mild (17.6%) cases. Hemorrhage was only reported in 4.1% of the observed neonatal thrombocytopenia cases. CONCLUSION This review provides preliminary evidence that neonatal thrombocytopenia incidence is high in infants born to mothers with immune thrombocytopenic purpura. This study further reports that the largest proportion of these cases are severe.
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Affiliation(s)
- Hongqiang Luo
- Department of Hematology, The First Affiliated Hospital of Shaoxing University, Shaoxing People's Hospital, Shaoxing, China
| | - Dan Li
- Department of Hematology, The First Affiliated Hospital of Shaoxing University, Shaoxing People's Hospital, Shaoxing, China
| | - Feidan Gao
- Department of Hematology, The First Affiliated Hospital of Shaoxing University, Shaoxing People's Hospital, Shaoxing, China
| | - Pan Hong
- Department of Hematology, The First Affiliated Hospital of Shaoxing University, Shaoxing People's Hospital, Shaoxing, China
| | - Weiying Feng
- Department of Hematology, The First Affiliated Hospital of Shaoxing University, Shaoxing People's Hospital, Shaoxing, China
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17
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Effect of perinatal factors on platelet indices in late preterm and term newborns. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.895718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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18
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Moiseiwitsch N, Brown AC. Neonatal coagulopathies: A review of established and emerging treatments. Exp Biol Med (Maywood) 2021; 246:1447-1457. [PMID: 33858204 DOI: 10.1177/15353702211006046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite the relative frequency of both bleeding and clotting disorders among patients treated in the neonatal intensive care unit, few clear guidelines exist for treatment of neonatal coagulopathies. The study and treatment of neonatal coagulopathies are complicated by the distinct hemostatic balance and clotting components present during this developmental stage as well as the relative scarcity of studies specific to this age group. This mini-review examines the current understanding of neonatal hemostatic balance and treatment of neonatal coagulopathies, with particular emphasis on emerging treatment methods and areas in need of further investigative efforts.
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Affiliation(s)
- Nina Moiseiwitsch
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Raleigh, NC 27695, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695, USA
| | - Ashley C Brown
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Raleigh, NC 27695, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695, USA
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19
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Saber AM, Aziz SP, Almasry AZE, Mahmoud RA. Risk factors for severity of thrombocytopenia in full term infants: a single center study. Ital J Pediatr 2021; 47:7. [PMID: 33436048 PMCID: PMC7802304 DOI: 10.1186/s13052-021-00965-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
Background Neonatal thrombocytopenia (NT) (platelet count < 150 × 109/L) is a common finding in the neonatal intensive care unit (NICU). The main aim of this study was to assess the prevalence, risk factors, and outcomes of severe NT in full term (FT) infants. Methods During the study period, all FT infants who met the inclusion criteria for NT on two occasions were included. Maternal data, such as maternal age, weight, gestational age, mode of delivery, and history of systemic diseases, including diabetes mellitus, pre-eclampsia, systemic lupus erythematosus, and immune thrombocytopenic purpura, were recorded. Furthermore, neonatal data, such as gender, neonatal weight, causes/duration of admission, types of respiratory support used, complete blood count measurements, and outcomes for neonates admitted to the NICU, were recorded. Results In total, 55 FT infants with NT met the inclusion criteria, and 29 (52.73%) cases had severe NT. The most common cause of NT was neonatal sepsis (20 cases, 36.35%), followed by a postoperative state (5 cases, 9.09%). Moreover, in cases of positive blood cultures, the most commonly isolated organism was Escherichia coli (6 cases, 10.90%), followed by Klebsiella (5 cases, 9.09%). Cases of severe NT needed more platelet transfusions (P = 0.001) and had higher rates of mortality (P = 0.001) when compared to cases of mild/moderate NT associated with signs of bleeding and pulmonary/intraventricular hemorrhage (IVH) (P = 0.001). Conclusion Severe NT compared to mild/moderate NT, associated with signs of bleeding and pulmonary/IVH, needed more platelet transfusions, and had increased mortality. Further research is needed to explain which of these complications related to severity of thrombocytopenia or were associated with original disease of the babies.
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Affiliation(s)
- Amira M Saber
- Department of Pediatrics, Faculty of Medicine, Sohag University, 15 University Street, Sohag, 82524, Egypt
| | - Shereen P Aziz
- Department of Clinical Pathology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Al Zahraa E Almasry
- Department of Pediatrics, Faculty of Medicine, Sohag University, 15 University Street, Sohag, 82524, Egypt
| | - Ramadan A Mahmoud
- Department of Pediatrics, Faculty of Medicine, Sohag University, 15 University Street, Sohag, 82524, Egypt.
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20
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Go H, Ohto H, Nollet KE, Kashiwabara N, Chishiki M, Hoshino M, Ogasawara K, Kawasaki Y, Momoi N, Hosoya M. Perinatal factors affecting platelet parameters in late preterm and term neonates. PLoS One 2020; 15:e0242539. [PMID: 33211743 PMCID: PMC7676724 DOI: 10.1371/journal.pone.0242539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 11/04/2020] [Indexed: 12/21/2022] Open
Abstract
Platelets parameters including platelet count (PLT), plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) are associated with various physiological and pathological functions in various disease. However, few studies have addressed whether perinatal factors may be associated with platelet parameters at birth in a large cohort of late preterm and term neonates. The aim of this study to investigate perinatal factors affecting platelet parameters in late preterm and term neonates. We retrospectively investigated platelet parameters including PLT, PCT, MPV, and PDW on the first day of life in 142 late preterm and 258 term neonates admitted to our NICU from 2006 through 2020. PLT, MPV, PCT, PDW on Day 0 did not significantly differ between the two groups. In term neonates, multivariate analysis revealed that PCT correlated with being small for gestational age (SGA) (β = -0.168, P = 0.006), pregnancy induced hypertension (PIH) (β = -0.135, P = 0.026) and male sex (β = -0.185, P = 0.002). PLT was associated with SGA (β = -0.186, P = 0.002), PIH (β = -0.137, P = 0.024) and male sex (β = -0.166, P = 0.006). In late preterm neonates, multivariate analysis revealed that PLT were associated with PIH, whereas no factors associated with PDW and MPV were found. In all patients studied, chorioamnionitis (CAM) was significantly associated with MPV (CAM = 10.3 fL vs. no CAM = 9.7 fL, P<0.001). Multivariate analysis showed that SGA, male sex and PIH were associated with PCT and PLT. This study demonstrates that different maternal and neonatal complications affect platelet parameters in late preterm and term neonates.
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Affiliation(s)
- Hayato Go
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
- * E-mail:
| | - Hitoshi Ohto
- Department of Advanced Cancer Immunotherapy, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kenneth E. Nollet
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Nozomi Kashiwabara
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mina Chishiki
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masato Hoshino
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kei Ogasawara
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yukihiko Kawasaki
- Department of Pediatrics, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Nobuo Momoi
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
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21
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Resch B. Thrombocytopenia in Neonates. Platelets 2020. [DOI: 10.5772/intechopen.92857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Thrombocytopenia defined as platelet count below 150,000/μL is not an uncommon event at the neonatal intensive care unit (NICU). In our region we calculated a prevalence of nearly 2 of 1000 live births. Early-onset neonatal thrombocytopenia (NT) occurring within the first 72 hours of life is more common than late-onset NT. Preterm infants are affected more often than term infants and bacterial infection is the most common diagnosis associated with NT. There are a lot of maternal, perinatal, and neonatal causes associated with NT and complications include bleedings with potentially life-threatening intracranial hemorrhage. Alloimmune thrombocytopenia (NAIT) often presents with severe thrombocytopenia (<30,000/μL) in otherwise healthy newborns and needs careful evaluation regarding HPA-1a antigen status and HLA typing. Platelet transfusions are needed in severe NT and threshold platelet counts might be at ≤25,000/μL irrespective of bleeding or not. Immune mediated NT recovers within 2 weeks with a good prognosis when there happened no intracranial hemorrhage. This short review gives an overview on etiology and causes of NT and recommendations regarding platelet transfusions.
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22
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Alsaleem M. Intravenous Immune Globulin Uses in the Fetus and Neonate: A Review. Antibodies (Basel) 2020; 9:E60. [PMID: 33158209 PMCID: PMC7709108 DOI: 10.3390/antib9040060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/07/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023] Open
Abstract
Intravenous immune globulin (IVIG) is made after processing plasma from healthy donors. It is composed mainly of pooled immunoglobulin and has clinical evidence-based applications in adult and pediatric populations. Recently, several clinical applications have been proposed for managing conditions in the neonatal population, such as hemolytic disease of the newborn, treatment, and prophylaxis for sepsis in high-risk neonates, enterovirus parvovirus and COVID-19 related neonatal infections, fetal and neonatal immune-induced thrombocytopenia, neonatal hemochromatosis, neonatal Kawasaki disease, and some types of immunodeficiency. The dosing, mechanism of action, effectiveness, side effects, and adverse reactions of IVIG have been relatively well studied in adults but are not well described in the neonatal population. This review aims to provide the most recent evidence and consensus guidelines about the use of IVIG in the fetus and neonate.
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Affiliation(s)
- Mahdi Alsaleem
- Pediatrics Department, Neonatology, Children’s Mercy Hospital, Kansas City, MO 64108, USA;
- Pediatrics Department, University of Kansas, Wichita, KS 67208, USA
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23
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Tigabu Kebede Z, Matebe YH, Demisse AG, Yimer MA, Mekasha A, Worku A, Demtse Gebremedhin A, McClure EM, Nigussie AK, Worku B, Gidi NW, Metaferia G, Goldenberg RL, Muhe LM. Hematologic Profiles of Ethiopian Preterm Infants With Clinical Diagnoses of Early-Onset Sepsis, Perinatal Asphyxia, and Respiratory Distress Syndrome. Glob Pediatr Health 2020; 7:2333794X20960264. [PMID: 33088853 PMCID: PMC7545762 DOI: 10.1177/2333794x20960264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/28/2020] [Accepted: 07/16/2020] [Indexed: 12/02/2022] Open
Abstract
Objective. To determine the hematologic profile of preterm infants with regard to different diseases. Methods. A prospective, cross-sectional, observational study, conducted in 5 hospitals in Ethiopia from July 2016 to May 2018. Preterm babies <7 days of age were included and investigated with complete blood counts (CBC) and other investigations, accordingly. Results. Out of 4919 preterms, 3852 (78.3%) were admitted to a newborn intensive care unit, and of these, 68.3% had a CBC performed. The mean values of hemoglobin, white blood cell (WBC) and platelet counts were 17.9 mg/dL; 12 685 cells/mm3, and 159 340 cells/mm3, respectively. Early onset neonatal sepsis (EONS) 1433 (37%), asphyxia 266 (6.9%), and respiratory distress syndrome (RDS) 1738 (45.3%) were common reasons for admission. The WBC count was <5000 cells/mm3 for 8.8%, 9.0%, and 11.1% of neonates with EONS, asphyxia and RDS, respectively. The hemoglobin value was <7 mg/dL for 0.6%, 1.7%, and 0.4% of preterm infants with EONS, asphyxia, and RDS, respectively. The platelet count was <50 000 cells/mm3 for 16.8%, 17.7%, and 19.8% of preterms admitted with a diagnosis of EONS, asphyxia, and RDS, respectively. Conclusion. WBC and platelet counts were the most common to be associated with EONS, asphyxia, and RDS. Further study is recommended to determine the effect of abnormal hematologic profile on the outcome of preterm babies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | | | | | | | - Lulu M Muhe
- Addis Ababa University, Addis Ababa, Ethiopia
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24
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Wolf MF, Childers J, Gray KD, Chivily C, Glenn M, Jones L, Kpa M, McMannen T, Reyes I, Zimmerman KO, Clark RH, Greenberg RG. Exchange transfusion safety and outcomes in neonatal hyperbilirubinemia. J Perinatol 2020; 40:1506-1512. [PMID: 32152492 PMCID: PMC8021453 DOI: 10.1038/s41372-020-0642-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To characterize the prevalence of exchange transfusion (ET), clinical characteristics of infants receiving ET, and ET-associated morbidity and mortality. STUDY DESIGN We conducted a multicenter cohort study of infants ≥23 weeks of gestational age (GA) with hyperbilirubinemia who underwent ET within 30 days of birth from 1997 to 2016. We examined clinical characteristics and adverse events after ET. We used multivariable logistic regression to examine the association between clinical risk factors and death. RESULT A total of 1252 infants were included; 4% died within 7 days of ET and 6% died before discharge. Compared with infants ≥37 weeks of GA, infants ≤29 weeks of GA had greater odds of death (adjusted odds ratio [95% confidence interval] = 20.08 [7.32, 55.07]). CONCLUSIONS Infants ≤ 29 weeks of GA had greater odds of death following ET compared with term infants. These data will support clinicians in evaluating risks and prognosis for infants who require ET.
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Affiliation(s)
- Mattie F Wolf
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Julie Childers
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Keyaria D Gray
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Caroline Chivily
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Mike Glenn
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Laila Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Mini Kpa
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Taylor McMannen
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Isaias Reyes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kanecia O Zimmerman
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
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25
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Miao J, Ren Z, Rao Y, Xia X, Wang J, Xu F, Zhang X, Yang J. Pathological staging of chorioamnionitis contributes to complications in preterm infants. Ital J Pediatr 2020; 46:127. [PMID: 32917243 PMCID: PMC7488745 DOI: 10.1186/s13052-020-00895-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/02/2020] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the effect of pathological staging of chorioamnionitis (CA) on complications in preterm infants; Methods A single-center, retrospective study was conducted to choose singleton preterm infants (gestational age < 37 weeks) from the Department of Obstetrics and Gynecology in our hospital from December 2016 to December 2017. The basic data and placental pathological results were retrospectively collected. According to the placental pathological results of whether inflammation infiltrating amnion, CA 0/I phase was classified into non-amnionitis group, CA II/III phase was classified into amnionitis group, the incidence of common complications in preterm infants was compared. Further, logistic regression was used to analyze the effects of amnionitis on complications after being adjusted to gestational age, birth weight and thrombocytopenia. Results A total of 221 preterm infants were enrolled, including 186 cases in non-amnionitis group and 35 cases in amnionitis group. The gestational age of amnionitis group (32.00 ± 2.71 weeks) was significantly lower than non-amnionitis group (34.14 ± 2.06 weeks), birth weight (1.93 ± 0.64 kg) was significantly lower than that of non-amnionitis group (2.26 ± 0.58 kg), and the hospital stay in amnionitis group was significantly longer (25.71 ± 19.23 days), all of the difference above was statistically significant(P < 0.05). The incidence of intraventricular hemorrhage (IVH) in amnionitis group (37.14%) was significantly higher than that in non-amnionitis group (13.98%) (P = 0.002), and the risk of IVH was significantly increased by amnionitis (OR = 3.636, 95%CI: 1.632–8.102); after correction of gestational age, birth weight and thrombocytopenia, the risk of IVH was still significantly increased (OR = 2.471, P = 0.046, 95% CI: 1.015–6.015). And the late-onset IVH was more common (P = 0.009). Conclusion Amnionitis leads to a significant reduction in gestational age and birth weight in preterm infants, and it is an independent risk factor for IVH.
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Affiliation(s)
- Jiayu Miao
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Zhuxiao Ren
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yunbei Rao
- Department of Neonatology, Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China
| | - Xin Xia
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jianlan Wang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Fang Xu
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiaoling Zhang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jie Yang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China.
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26
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Raghuwanshi S, Dahariya S, Sharma DS, Kovuru N, Sahu I, Gutti RK. RUNX1 and TGF‐β signaling cross talk regulates Ca2+ion channels expression and activity during megakaryocyte development. FEBS J 2020; 287:5411-5438. [DOI: 10.1111/febs.15329] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/12/2020] [Accepted: 04/06/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Sanjeev Raghuwanshi
- Department of Biochemistry School of Life Sciences University of Hyderabad India
| | - Swati Dahariya
- Department of Biochemistry School of Life Sciences University of Hyderabad India
| | - Durga Shankar Sharma
- Department of Biochemistry School of Life Sciences University of Hyderabad India
| | - Narasaiah Kovuru
- Department of Biochemistry School of Life Sciences University of Hyderabad India
| | - Itishri Sahu
- Department of Biochemistry School of Life Sciences University of Hyderabad India
| | - Ravi Kumar Gutti
- Department of Biochemistry School of Life Sciences University of Hyderabad India
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Singh S, Singh VK, Rai G. Identification of Differentially Expressed Hematopoiesis-associated Genes in Term Low Birth Weight Newborns by Systems Genomics Approach. Curr Genomics 2020; 20:469-482. [PMID: 32655286 PMCID: PMC7327969 DOI: 10.2174/1389202920666191203123025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 11/29/2019] [Accepted: 11/29/2019] [Indexed: 11/22/2022] Open
Abstract
Background Low Birth Weight (LBW) (birth weight <2.5 Kg) newborns are associated with a high risk of infection, morbidity and mortality during their perinatal period. Compromised innate immune responses and inefficient hematopoietic differentiation in term LBW newborns led us to evaluate the gene expression status of hematopoiesis. Materials and Methods In this study, we compared our microarray datasets of LBW-Normal Birth Weight (NBW) newborns with two reference datasets to identify hematopoietic stem cells genes, and their differential expression in the LBW newborns, by hierarchical clustering algorithm using gplots and RcolorBrewer package in R. Results Comparative analysis revealed 108 differentially expressed hematopoiesis genes (DEHGs), of which 79 genes were up-regulated, and 29 genes were down-regulated in LBW newborns compared to their NBW counterparts. Moreover, protein-protein interactions, functional annotation and pathway analysis demonstrated that the up-regulated genes were mainly involved in cell proliferation and differentiation, MAPK signaling and Rho GTPases signaling, and the down-regulated genes were engaged in cell proliferation and regulation, immune system regulation, hematopoietic cell lineage and JAK-STAT pathway. The binding of down-regulated genes (LYZ and GBP1) with growth factor GM-CSF using docking and MD simulation techniques, indicated that GM-CSF has the potential to alleviate the repressed hematopoiesis in the term LBW newborns. Conclusion Our study revealed that DEHGs belonged to erythroid and myeloid-specific lineages and may serve as potential targets for improving hematopoiesis in term LBW newborns to help build up their weak immune defense against life-threatening infections.
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Affiliation(s)
- Sakshi Singh
- 1Department of Molecular and Human Genetics, Institute of Science, Banaras Hindu University, Varanasi, India; 2Centre for Bioinformatics, School of Biotechnology, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Vinay K Singh
- 1Department of Molecular and Human Genetics, Institute of Science, Banaras Hindu University, Varanasi, India; 2Centre for Bioinformatics, School of Biotechnology, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Geeta Rai
- 1Department of Molecular and Human Genetics, Institute of Science, Banaras Hindu University, Varanasi, India; 2Centre for Bioinformatics, School of Biotechnology, Institute of Science, Banaras Hindu University, Varanasi, India
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Esiaba I, Mousselli I, M. Faison G, M. Angeles D, S. Boskovic D. Platelets in the Newborn. NEONATAL MEDICINE 2019. [DOI: 10.5772/intechopen.86715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Pituitary adenylate cyclase-activating polypeptide (PACAP): Differential effects on neonatal vs adult megakaryocytopoiesis. Thromb Res 2019; 175:59-60. [DOI: 10.1016/j.thromres.2019.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/10/2019] [Accepted: 01/21/2019] [Indexed: 12/20/2022]
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A Prospective Study on the Incidence and Outcomes of Neonatal Thrombocytopenia at a Tertiary Care Facility in Central Saudi Arabia. Adv Neonatal Care 2018; 18:E3-E12. [PMID: 30044242 PMCID: PMC6155353 DOI: 10.1097/anc.0000000000000539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: The incidence of neonatal thrombocytopenia is low, yet highly dependent on the populations studied. Purpose: To assess the incidence of neonatal thrombocytopenia and identify factors associated with its outcomes, namely time to disease onset, recovery duration, and platelet count. Methods: A prospective observational study was conducted between May and October 2013 at a large tertiary care facility in Saudi Arabia. Neonates with a platelet count of fewer than 150,000/μL of blood were followed up until their recovery or death. Results: The period incidence of neonatal thrombocytopenia was 84/4379 (1.9%). The mortality rate associated with the condition was 68/100,000 births. The male-female ratio of neonates with thrombocytopenia was 2.4:1. The mean (standard deviation) time to disease onset was 1.83 (1.29) days, whereas that of recovery duration was 15.35 (18.46) days. The mean (standard deviation) platelet count at onset was 109,543 (32,826)/μL of blood, whereas that of the increase in platelet count from onset to recovery was 121,876 (78,218)/μL of blood. Treatment comprised monitoring/spontaneous recovery (n = 52, 64.2%) or platelet transfusion (n = 9, 11.1%), immunoglobulins (n = 8, 9.9%), or a combination of both (n = 12, 14.8%). Neonates with a higher gestational age (β = 8061, t = 2.456) and late disease onset (β = 26,178, t = 3.969) were more likely to have a larger increase in platelet count from onset to recovery than those with a lower gestational age (adjusted P = .017) and earlier disease onset (adjusted P < .001). Implications: The high incidence of neonatal thrombocytopenia in this Middle Eastern setting indicates that it may be dependent on the population studied. Special attention should be focused on neonates of lower gestational ages and with an early disease onset, because their platelet count recovery may be slower than that of the countergroup.
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Kumar Ray R, Panda S, Patnaik R, Sarangi G. A Study of Neonatal Thrombocytopenia in a Tertiary Care Hospital: A Prospective Study. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/0973217918766990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rajib Kumar Ray
- Department of Pediatrics, Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha, India (G.S.)
| | - Suchismita Panda
- Department of Pediatrics, Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha, India (G.S.)
| | - Rashmi Patnaik
- Department of Pediatrics, Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha, India (G.S.)
| | - Gadadhara Sarangi
- Department of Pediatrics, Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha, India (G.S.)
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Surti J, Jain I, Shah K, Mishra A, Kandre Y, Garg P, Shah J, Shah A, Tripathi P. Predictive efficacy of procalcitonin, platelets, and white blood cells for sepsis in pediatric patients undergoing cardiac surgeries who are admitted to intensive care units: Single-center experience. Ann Pediatr Cardiol 2018; 11:137-142. [PMID: 29922010 PMCID: PMC5963227 DOI: 10.4103/apc.apc_36_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Sepsis is one of the major contributor of morbidity and mortality in pediatric cardiac surgeries. Aim: The aim of this study was to compare the predictive efficacy of total leukocyte counts (TC), platelet count (PC), and procalcitonin (PCT) for sepsis in patients undergoing cardiac surgeries who are admitted to the Intensive Care Unit. Materials and Methods: This prospective, single-center study included 300 neonates, infants, and pediatric patients who had undergone various open heart surgeries at our center from September 2014 to November 2015. Results: Overall, the incidence of sepsis was 14% in pediatric patients undergoing cardiac surgeries. TC of postoperative 48 h were significantly lower (11889.19 ± 5092.86 vs. 14583.22 ± 6562.96; P = 0.004) in septic patients. The low levels of platelets on postoperative 24 h and 72 h were observed in patients with sepsis as compared to patients without sepsis, whereas the levels of PCT at various time intervals (preoperative, postoperative - 24 h, 48 h, and 72 h) had shown no association with sepsis in the study population. Low PC (24 h) was the strongest predictor of sepsis showing an odds ratio of 1.9 (95% confidence interval [CI]: 1.42–3.51; P = 0.001) and area under curve of 0.688 with 95% CI of 0.54–0.83 (P = 0.018). Conclusion: We may conclude that in Indian pediatric population platelet levels are highly associated with sepsis as compared to any other hematological parameter. The immediate postoperative level of platelet is the strongest predictor of sepsis and could be effectively used in the clinical settings.
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Affiliation(s)
- Jigar Surti
- U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Imelda Jain
- U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Komal Shah
- U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Amit Mishra
- U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Yogini Kandre
- U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Pankaj Garg
- U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Jatin Shah
- U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Ashok Shah
- U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Payal Tripathi
- U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
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Becocci A, Felice-Civitillo C, Laurent M, Boehlen F, De Luca R, Fluss J. Intracranial Hemorrhage and Autoimmune Thrombocytopenia in a Neonate: A Rare "Unpredictable" Event. Child Neurol Open 2018; 5:2329048X18768693. [PMID: 29662916 PMCID: PMC5894894 DOI: 10.1177/2329048x18768693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 11/17/2022] Open
Abstract
Neonatal thrombocytopenia is a rare complication of maternal autoimmune thrombocytopenia, and no maternal predictors of its gravity and potential complications have been identified. Neonatal cerebral hemorrhage, a feared event in the setting of autoimmune thrombocytopenia, is fortunately uncommon, but it can occur in utero or in the perinatal period, with potentially serious consequences. The authors report the case of a boy born to a mother affected by autoimmune thrombocytopenia, who presented with severe thrombocytopenia at birth and developed intracranial hemorrhage despite mild maternal thrombocytopenia at delivery and a prompt preventive treatment of the newborn. Platelet count should be tested at birth in all babies born from mothers with autoimmune thrombocytopenia, irrespective of maternal platelets counts during pregnancy or at delivery, and should be closely monitored during the first days of life. Systematic early and serial cranial ultrasound might be advocated in the setting of neonatal thrombocytopenia.
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Affiliation(s)
- Andrea Becocci
- Neonatology and Intensive Care Unit, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Méryle Laurent
- Pediatric Radiology Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Françoise Boehlen
- Division of Angiology and Hemostasis, University Hospitals of Geneva, Geneva, Switzerland
| | - Roberta De Luca
- Neonatology and Intensive Care Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Joel Fluss
- Pediatric Neurology Unit, Pediatric Subspecialties Service, University Hospitals of Geneva, Geneva, Switzerland
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Prevalence and Severity of Thrombocytopenia in Blood Culture Proven Neonatal Sepsis: A Prospective Study. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2018. [DOI: 10.5812/pedinfect.12471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shin HB, Yu NL, Lee NM, Yi DY, Yun SW, Chae SA, Lim IS. Predictive Factors for Severe Thrombocytopenia and Classification of Causes of Thrombocytopenia in Premature Infants. NEONATAL MEDICINE 2018. [DOI: 10.5385/nm.2018.25.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Hoon Bum Shin
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Na Li Yu
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Na Mi Lee
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dae Yong Yi
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sin Weon Yun
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soo Ahn Chae
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Seok Lim
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
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Neonatal thrombocytopenia-causes and outcomes following platelet transfusions. Eur J Pediatr 2018; 177:1045-1052. [PMID: 29705932 PMCID: PMC5997104 DOI: 10.1007/s00431-018-3153-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 02/02/2023]
Abstract
UNLABELLED We evaluated the causes for neonatal thrombocytopenia (NT), the duration of NT, and the indications of platelet transfusions (PT) by means of a retrospective cohort study over a 23-year period. Neonates with NT were identified via ICD-10 code D69.6. Of 371 neonates (1.8/1000 live births) with NT, the majority (312; 84.1%) had early onset thrombocytopenia, and 282 (76%) were preterm born. The most frequent causes for NT were early and late onset sepsis and asphyxia. The mean duration of thrombocytopenia was 10.2 days and was negatively correlated (KK = - 0.35) with the number of PT. PT were given to 78 (21%) neonates, 38 (49%) of whom had very severe NT. The duration of NT was positively related to the severity of NT and the number of subsequent PT. A mortality rate of 10.8% was significantly associated with bleeding signs (p < 0.05) and correlated with increasing number of PT (p < 0.05) but not with the severity of NT (p = 0.4). In the case of relevant hemorrhage, PT did not influence the mortality rate (p = 0.09). All deaths followed neonatal sepsis. CONCLUSIONS Prematurity and diagnoses including early and late onset sepsis and asphyxia were the most common causes of NT. Mortality was not associated with the severity of NT but increased with the number of PT. What is Known: • The causes for neonatal thrombocytopenia (NT) are well known. • The effects of platelet transfusions (PT) and its indications are still a matter of debate and recommendations differ widely. What is New: • The duration of NT is positively related to the severity of NT and the number of subsequent PT. • The mortality rate is not associated with the severity of NT but increases with increasing numbers of PT and in the case of relevant intraventricular hemorrhage (≥ grade II), PT does not influence the mortality rate.
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Marins LR, Anizelli LB, Romanowski MD, Sarquis AL. How does preeclampsia affect neonates? Highlights in the disease's immunity. J Matern Fetal Neonatal Med 2017; 32:1205-1212. [PMID: 29113524 DOI: 10.1080/14767058.2017.1401996] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Preeclampsia (PE) is the primary obstetrical cause in one of the four perinatal deaths. Although the etiology and pathogenesis of preeclampsia is not fully known, a proinflammatory immune state prevails and can disrupt fetal hematopoiesis. Some of the effects on the newborn include neonatal thrombocytopenia, neutropenia, a reduction in T regulatory cells, and an increased cytotoxic natural killer cell profile. METHODS Electronic databases were searched, and defined criteria were applied to select articles for review. The review covered literature on the effects on neonatal due to maternal preeclampsia, fetal outcomes, and new treatments in research aimed at reducing morbidity and mortality of the disease. DISCUSSION The cytotoxic environment present in PE affects the development of fetal cell lineages. Neutropenia is observed in 50% of neonates and is correlated with mortality, although its treatment is not well-established. The enhancement in erythropoietin and the hypoxic setting present in the disease can also lead to thrombocytopenia. Per partum management includes platelet transfusion in order to avoid severe complications such as intraventricular hemorrhage. Regarding other cell lines, a cytotoxic profile is observed to be reflecting the milieu present in the mothers' bloodstream. This disruption alters the immune system response into a proinflammatory profile and can be correlated to neonatal necrotizing enterocolitis. An antiangiogenic environment is also part of the preeclampsia presentation and can be responsible for the enhancement of bronchopulmonary dysplasia observed in this population. Meanwhile, the reduction in angiogenic factors, such as vascular endothelial growth factor (VEGF), can be a protective mechanism for retinopathy of prematurity. Studies of the long-term effects of these observations are lacking, but lower neurodevelopmental scores and a higher cardiovascular risk are noted. New treatments in research propose a prevention of the disease during gestation in order to reduce the effects more efficiently in the fetus. Phosphodiesterase inhibitors, endothelin 1 receptor antagonists and manipulation of heme oxygenase-1 enzyme pathway are possible therapeutic alternatives. This review summarizes the current understanding of how preeclampsia affects neonates. As a conclusion, further studies are needed to build up a guideline to manage those effects. A research agenda is proposed.
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Affiliation(s)
- Lina R Marins
- a Department of Child and Adolescent Health , Universidade Federal do Paraná , Curitiba , Brazil
| | - Leonardo B Anizelli
- a Department of Child and Adolescent Health , Universidade Federal do Paraná , Curitiba , Brazil
| | - Mariana D Romanowski
- b Department of Gynecology and Obstetrics , Universidade Federal do Paraná , Curitiba , Brazil
| | - Ana L Sarquis
- a Department of Child and Adolescent Health , Universidade Federal do Paraná , Curitiba , Brazil
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Refsum E, Håkansson S, Mörtberg A, Wikman A, Westgren M. Intracranial hemorrhages in neonates born from 32 weeks of gestation-low frequency of associated fetal and neonatal alloimmune thrombocytopenia: a register-based study. Transfusion 2017; 58:223-231. [DOI: 10.1111/trf.14394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Erle Refsum
- Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
| | - Stellan Håkansson
- Department of Clinical Sciences, Pediatrics; Umeå University; Umeå Sweden
| | - Anette Mörtberg
- Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Agneta Wikman
- Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Magnus Westgren
- Department of Obstetrics and Gynecology; Karolinska University Hospital; Stockholm Sweden
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Serious Bacterial Infections in Hospitalized Febrile Infants in the First and Second Months of Life. Pediatr Infect Dis J 2017; 36:924-929. [PMID: 28471863 DOI: 10.1097/inf.0000000000001632] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Most protocols evaluating serious bacterial infection (SBI) risk in febrile infants classify neonates <30 days of age as high risk (HR), while other protocols do not distinguish between infants <30 and 30-60 days of age. We compared SBI rates in febrile infants at the first and the second months of life. METHODS This was a retrospective, population-based, cohort study. All febrile infants ≤60 days of age hospitalized in southern Israel, January 2013 through May 2014, were included. SBI risk assessment included medical history, physical examination, blood count and dipstick urine analysis. RESULTS Overall, 623 infants were identified; 142 HR infants <30 days of age, 95 low-risk (LR) infants <30 days of age, 232 HR infants 30-60 days of age and 154 LR infants 30-60 days of age. Urinary tract infection comprised 84.7% (133/157) of all SBIs. Among HR infants, higher SBI rates were observed in <30 versus 30-60 days (45.0% vs. 29.3%; P = 0.003), while respective rates were similar among LR infants (8.4% vs. 11.0%; P = 0.66). SBI rates in HR infants 0-14 versus 15-60 days of age were 45.3% versus 33.6% (P = 0.12), and 19.2% versus 8.9% (P = 0.15) in LR infants. Among HR infants, SBI rates were 52.8% and 39.5% in infants <30 days of age with temperature ≥39°C and <39°C, respectively, while in infants ≥30 days of age, respective rates were 31.2% and 26.7% (P = 0.005, comparing the 4 groups). Among LR infants, rates were not affected by temperature degree. Thrombocytopenia was associated with higher SBI rates in HR, but not in LR. CONCLUSIONS In HR infants, higher SBI rates were associated with younger age, higher body temperature and thrombocytopenia. In contrast, SBI (mostly urinary tract infection) rates among LR infants (approximately 10%) were not associated with these factors.
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[Thirty years of platelet immunology in fetal and neonatal alloimmune thrombocytopenia management, current situation]. Transfus Clin Biol 2017; 24:166-171. [PMID: 28673503 DOI: 10.1016/j.tracli.2017.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/30/2017] [Indexed: 11/21/2022]
Abstract
Fetal and neonatal allo-immune thrombocytopenia (FNAIT) is considered as a rare disease due to the incidence (1/1000-1/2000 births). The major complication of severe thrombocytopenia is bleeding and particularly intra-cranial hemorrhage and neurologic sequelae following. Serology and molecular biology developments have reconfigured the platelet immunology diagnosis. Anti-HPA-1a allo-immunisation is responsible for more than 80% FNAIT cases with a high recurrence rate of severe bleeding complications. Therapeutic management has changed over the coming years from an invasive concept associating fetal blood sampling and in utero platelet transfusion to a non invasive treatment by intravenous immunoglobulins injection (IVIg). The purpose of this article is to provide an update on FNAIT management in the light of current developments over the past 30years.
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Winkelhorst D, Oepkes D, Lopriore E. Fetal and neonatal alloimmune thrombocytopenia: evidence based antenatal and postnatal management strategies. Expert Rev Hematol 2017. [PMID: 28644735 DOI: 10.1080/17474086.2017.1346471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a relatively rare but potentially lethal disease, leading to severe bleeding complications in 1 in 11.000 newborns. It is the leading cause of thrombocytopenia in healthy term-born neonates. Areas covered: This review summarizes the antenatal as well as postnatal treatment, thus creating a complete overview of all possible management strategies for FNAIT. Expert commentary: The optimal antenatal therapy in order to prevent bleeding complications in pregnancies complicated by FNAIT is non-invasive treatment with weekly intravenous immunoglobulin (IVIG). Based on risk stratification, weekly doses of IVIG of 0.5 or 1.0g/kg should be administered started early in the second in high risk cases or at the end of the second trimester in low risk cases. The optimal postnatal treatment depends on the platelet count and the clinical condition of the newborn. Prompt administration of compatible platelet transfusion is the first treatment of choice in case of severe thrombocytopenia or active bleeding. In case matched platelets are not directly available, random platelets can also be administered initially to gain time until matched platelets are available. In case of persistent thrombocytopenia despite transfusions, IVIG 1.0-2.0g/kg can be administered.
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Affiliation(s)
- Dian Winkelhorst
- a Division of Fetal Therapy, Department of Obstetrics , Leiden University Medical Center , Leiden , The Netherlands.,b Department Immunohematology Experimental , Sanquin , Amsterdam , The Netherlands
| | - Dick Oepkes
- a Division of Fetal Therapy, Department of Obstetrics , Leiden University Medical Center , Leiden , The Netherlands
| | - Enrico Lopriore
- c Division of Neonatology, Department of Pediatrics , Leiden University Medical Center , Leiden , The Netherlands
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Petermann R. [Platelet transfusion role in neonatal immune thrombocytopenia]. Transfus Clin Biol 2016; 23:217-221. [PMID: 27592154 DOI: 10.1016/j.tracli.2016.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
Abstract
Neonatal immune thrombocytopenia represent less than 5% of cases of early thrombocytopenia (early-onset<72hours post-delivery). As in adults, thrombocytopenia in neonates is defined as a platelet count less than 150G/L. They are either auto- or allo-immune. Thrombocytopenia resulting from transplacental passage of maternal antibodies directed to platelet membrane glycoproteins can be severe. The major complication of severe thrombocytopenia is bleeding and particularly intra-cranial haemorrhage and neurologic sequelea following. However, auto- and allo-immune thrombocytopenia have very different characteristics including the treatment management. In fact, this treatment is based on platelet transfusion associated or not to intravenous immunoglobulin administration. The purpose of this article is to remind platelet transfusion's place in neonatal immune thrombocytopenia in terms of recently published French guidelines and international practices.
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Affiliation(s)
- R Petermann
- Département d'immunologie plaquettaire, Institut national de la transfusion sanguine, 75015 Paris, France.
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Kulkarni VV, Dutta S, Sundaram V, Saini SS. Preterm Thrombocytopenia and Delay of Ductus Arteriosus Closure. Pediatrics 2016; 138:peds.2016-1627. [PMID: 27681010 DOI: 10.1542/peds.2016-1627] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate whether preterm thrombocytopenia within 24 hours of birth is associated with delayed closure of patent ductus arteriosus (PDA) and higher proportion of hemodynamically significant PDA (Hs-PDA). METHODS Neonates (gestation 260/7-336/7 weeks, age <24 hours) with known platelet count and PDA on echocardiogram were prospectively enrolled. Asphyxia, congenital infections, structural heart disease, major malformations and clinical sepsis were exclusions. Subjects were recruited in groups A (n = 35), B (n = 18), and C (n = 17) [platelet counts >150,000, 100,000-150,000 and <100,000 per μL respectively] and underwent daily echocardiography until first closure of PDA, death, or day 10. RESULTS The primary outcome was time to first closure of PDA. Secondary outcomes included proportion with PDA at 72 hours and 7 days, Hs-PDA, and PDA needing treatment. In groups A, B, and C, median (first-third quartile) platelet counts (×100000/μL) were 2.28 (1.94-3.19), 1.25 (1.14-1.37), and 0.68 (0.54-0.83) and time to PDA closure was 2 (2-2), 2 (2-3), and 10 (6-10) days, respectively (log-rank test, P < .001). On Cox proportional hazard regression, platelet count (in multiples of 10 000 /μL) independently predicted time to PDA closure (adjusted hazard ratio: 1.045; 95% confidence interval: 1.019-1.07). On day 7, 47.1% neonates in group C had PDA and none in groups A and B (P < .001). CONCLUSIONS Thrombocytopenia within 24 hours of birth independently predicts delayed PDA closure and PDA on day 7 in preterm neonates.
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Affiliation(s)
- Vinay Vamadev Kulkarni
- Newborn Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sourabh Dutta
- Newborn Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Venkataseshan Sundaram
- Newborn Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shiv Sajan Saini
- Newborn Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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44
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Corticosteroids compared with intravenous immunoglobulin for the treatment of immune thrombocytopenia in pregnancy. Blood 2016; 128:1329-35. [PMID: 27402971 DOI: 10.1182/blood-2016-04-710285] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 07/05/2016] [Indexed: 11/20/2022] Open
Abstract
Treatment options for immune thrombocytopenia (ITP) in pregnancy are limited, and evidence to guide management decisions is lacking. This retrospective study of singleton pregnancies from 2 tertiary centers compared the effectiveness of intravenous immunoglobulin (IVIg) and corticosteroids in treatment of ITP. Data from 195 women who had 235 pregnancies were reviewed. Treatment was not required in 137 pregnancies (58%). Of the remaining 98 pregnancies in 91 women, 47 (48%) were treated with IVIg and 51 were treated with corticosteroids as the initial intervention. Mean maternal platelet count at birth did not differ between groups (IVIg 69 × 10(9)/L vs corticosteroids 77 × 10(9)/L; P = .71) nor did the proportion of mothers who achieved a platelet count response (IVIg 38% vs corticosteroids 39%; P = .85). There were no fatal or severe maternal, fetal, or neonatal hemorrhages. Of 203 neonates in whom platelet counts were available, 56 (28%) had a birth platelet count <150 × 10(9)/L and 18 (9%) had platelet counts <50 × 10(9)/L. Nadir platelet counts for most affected neonates occurred at birth, although for some neonates, nadir platelet counts occurred up to 6 days postnatally. Intracranial hemorrhage was noted in 2 neonates (nadir platelet counts were 135 and 18 × 10(9)/L). There were no neonatal deaths. The majority of pregnant women with a history of ITP did not require treatment, and neonatal outcomes were comparable for mothers who received IVIg or corticosteroids for treatment of maternal ITP.
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Motta M, Tincani A, Lojacono A, Faden D, Gorla R, Airò P, Neri F, Gasparoni A, Ciardelli L, de Silvestri A, Marconi M, Chirico G. Neonatal outcome in patients with rheumatic disease. Lupus 2016; 13:718-23. [PMID: 15485111 DOI: 10.1191/0961203403lu2002oa] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rheumatic autoimmune diseases have a higher prevalence in women, particularly during their childbearing age. Due to improved management, an increasing number of patients plan and carry out one or more pregnancies. Therefore, a growing interest is being paid to the possible consequences of maternal disease and associated treatment on the fetus and newborn infant. If maternal disease is characterized by the presence of IgG isotype autoantibodies, these can cross the placenta with possible antibody-mediated damage to the fetus. This is typically the case of the so called neonatal lupus erythematosus (NLE); a similar mechanism has been shown in infants of patients with immune thrombocytopenic purpura (ITP) and, less frequently, in those from mothers with antiphospholipid syndrome (APS). Indeed, this last condition is often responsible for placental, rather than neonatal, pathology. In addition, immunosuppressive and other drugs administered to the mothers during pregnancy and lactation might affect the fetal and neonatal immune system development. Finally, mothers disease and/or treatment could be related to neuropsychological alteration reported in some of their children.
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Affiliation(s)
- M Motta
- Neonatology and Neonatal Intensive Care, Spedali Civili, Brescia, Italy.
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Mitra S, Chan AK, Paes BA. The association of platelets with failed patent ductus arteriosus closure after a primary course of indomethacin or ibuprofen: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2016; 30:127-133. [DOI: 10.3109/14767058.2016.1163684] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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47
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Kalagiri RR, Choudhury S, Carder T, Govande V, Beeram MR, Uddin MN. Neonatal Thrombocytopenia as a Consequence of Maternal Preeclampsia. AJP Rep 2016; 6:e42-7. [PMID: 26929869 PMCID: PMC4737627 DOI: 10.1055/s-0035-1565923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/26/2015] [Indexed: 10/25/2022] Open
Abstract
Introduction Preeclampsia (preE) is pregnancy-induced hypertension affecting a significant proportion of pregnant women worldwide and can cause detrimental effects in the mother and newborn. Some of the effects in the newborn include neonatal thrombocytopenia. Pertaining specifically to neonatal thrombocytopenia, several questions remain unanswered. Discussion According to the current literature, neonatal thrombocytopenia due to maternal preE is highly prevalent in the general population and the incidence is reported to be around 30% worldwide. This review gives an insight into the syndrome and summarizes the possible pathological mechanisms, the diagnostic approach, complications, and therapeutic interventions of neonatal thrombocytopenia. It also identifies the involvement of other cell lines, apart from platelets in the newborns. Furthermore, we suggest a future prospective study to investigate the pathogenesis of preE and plan a study involving animal models to come up with a possible therapeutic intervention to prevent preE and its various consequences in neonates.
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Affiliation(s)
- Ram R Kalagiri
- Department of Neonatology, Baylor Scott & White Healthcare, Temple, Texas; Baylor Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Saiara Choudhury
- Baylor Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Timothy Carder
- Baylor Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Vinayak Govande
- Department of Pediatrics, Baylor Scott & White Healthcare, Temple, Texas
| | - Madhava R Beeram
- Department of Neonatology, Baylor Scott & White Healthcare, Temple, Texas; Baylor Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, Texas; Department of Pediatrics, Baylor Scott & White Healthcare, Temple, Texas
| | - M Nasir Uddin
- Baylor Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, Texas; Department of Pediatrics, Baylor Scott & White Healthcare, Temple, Texas; Departments of Obstetrics & Gynecology, Baylor Scott & White Healthcare, Temple, Texas; Department of Internal Medicine, Baylor Scott & White Healthcare, Temple, Texas
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48
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Cremer M, Sallmon H, Kling PJ, Bührer C, Dame C. Thrombocytopenia and platelet transfusion in the neonate. Semin Fetal Neonatal Med 2016; 21:10-8. [PMID: 26712568 DOI: 10.1016/j.siny.2015.11.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Neonatal thrombocytopenia is widespread in preterm and term neonates admitted to neonatal intensive care units, with up to one-third of infants demonstrating platelet counts <150 × 10(9)/L. Thrombocytopenia may arise from maternal, placental or fetal/neonatal origins featuring decreased platelet production, increased consumption, or both mechanisms. Over the past years, innovations in managing neonatal thrombocytopenia were achieved from prospectively obtained clinical data on thrombocytopenia and bleeding events, animal studies on platelet life span and production rate and clinical use of fully automated measurement of reticulated platelets (immature platelet fraction). This review summarizes the pathophysiology of neonatal thrombocytopenia, current management including platelet transfusion thresholds and recent developments in megakaryopoietic agents. Furthermore, we propose a novel index score for bleeding risk in thrombocytopenic neonates to facilitate clinician's decision-making when to transfuse platelets.
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Affiliation(s)
- Malte Cremer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Germany.
| | - Hannes Sallmon
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Germany
| | - Pamela J Kling
- Department of Pediatrics, University of Wisconsin - Madison, Madison, WI, USA
| | - Christoph Bührer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Germany
| | - Christof Dame
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Germany
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Abstract
This article reviews and updates the state of the art on the hematologic aspects related to neonatal sepsis in preterm neonates in the neonatal intensive care unit and overviews all hematologic changes occurring during neonatal infections and their implications both as diagnostic and prognostic parameters to guide clinicians at the patients' bedside.
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Affiliation(s)
- Paolo Manzoni
- Division of Neonatology and NICU, Sant'Anna Hospital, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino 10126, Italy.
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Elmoneim AA, Zolaly M, El-Moneim EA, Sultan E. Prognostic significance of early platelet count decline in preterm newborns. Indian J Crit Care Med 2015; 19:456-61. [PMID: 26321804 PMCID: PMC4548414 DOI: 10.4103/0972-5229.162462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Decline of platelets with or without thrombocytopenia is observed in critically ill preterm newborns. Prognostic significance of platelets count in Neonatal Intensive Care Unit focused on outcome after thrombocytopenia. We aimed to estimate the changes in platelets count within the first 7 days of life in preterm newborns and its relation to final outcomes. METHODS Retrospectively, the platelets count during the first 7 days of life, and its association with mortality, length of stay among survivors (LOS), and later severe morbidities were determined. Appropriate regression analyses were used to examine possible relations between studied variables. RESULTS AND DISCUSSION Platelets drop that did not reach thrombocytopenia level in the first 7 days of life happened in 61.7%. Platelets count drop in the first 7 days of life was a predictor of mortality, LOS, and major morbidities such as intraventricular hemorrhage and necrotizing enterocolitis. CONCLUSIONS Platelets count drop within the first 7 days of life independent of thrombocytopenia can be used to predict increased mortality, LOS, and the development of later severe morbidities in critically ill preterm neonates.
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Affiliation(s)
- Abeer Abd Elmoneim
- Department of Pediatric, Taibah University, Almadinah Almounourah, Saudi Arabia ; Department of Pediatric, Sohag University, Sohag, Egypt
| | - Mohammed Zolaly
- Department of Pediatric, Taibah University, Almadinah Almounourah, Saudi Arabia
| | - Ehab Abd El-Moneim
- Department of Pediatric, Taibah University, Almadinah Almounourah, Saudi Arabia ; Department of Pediatric, Sohag University, Sohag, Egypt
| | - Eisa Sultan
- Department of Pediatric, Neonatal Unit, Ohoud Hospital, Almadinah Almounourah, Saudi Arabia
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