895 CLINICAL IMPACT OF NEONATAL THROMBOCYTOPENIA–A PROSPECTIVE ONE YEAR STUDY

Thrombocytopenia is frequently (22%) observed in a neonatal intensive care unit but the relative hemostatic risk imposed by the thrombocytopenia has not been extensively studied. We have conducted a prospective, comparative study of 97 consecutive neonates in the intensive care unit with platelet counts <100×109/L and 80 age and disease matched neonates with normal platelet counts (> 150×109/L). The clinical impact was assessed by: 1. a modified template bleeding time; 2. investigation for the presence of intraventricular hemorrhage (IVH) in infants < 1500 gm and 3. evaluation of each infant for bleeding using a hemorrhage score (0-10). This study demonstrated that thrombocytopenia is not only a laboratory abnormality but has a significant impact on the hemostatic integrity of the neonate. The bleeding time was inversely related to the platelet count and became progressively more prolonged when the platelet count fell below 100×109/L. The frequency of IVH in the thrombocytopenic infants was 82% compared to 50% in the controls (x2, p < 0.001). Clinical hemorrhage occurred in 86% of the thrombocytopenic infants compared to 35% of the controls (x2, p < 0.001) with the hemorrhage score being highest in infants with the most severe thrombocytopenia. Possible etiologic factors such as umbilical catheters, phototherapy, polycythemia, maternal or infant drugs and suspected or proven sepsis were equally distributed between both groups. This study demonstrates that thrombocytopenia in the neonate positively correlates with an increased risk of hemorrhage.