Öz

Objective: Late-onset neonatal sepsis (LOS) is frequently complicated with thrombocytopenia. The aim of this study was determine the prevalence of LOS, and whether platelet indices affect LOS and mortality in neonates with thrombocytopenia in the neonatal intensive care unit (NICU) population.

Materials and Methods: This retrospective observational cohort study included neonates admitted to a level 4 NICU between 2018 and 2022 who developed thrombocytopenia (platelet count <150×10⁹/L). Platelet indices were recorded during thrombocytopenic episodes preceding or coinciding with late-onset sepsis (LOS). Multivariable logistic regression and Cox proportional hazards models were used.

Results: A total of 223 (13.3%) thrombocytopenic neonates were included in the study. According to multivariable logistic regression analysis, multiparity (OR: 3.32 95% CI 1.40-7.89, p=0.006), caesarean section (OR: 5.81, 95% CI 1.99-16.89, p<0.001), invasive ventilation (OR: 8.43 95% CI 3.60-19.75, p<0.001, high MPV levels (OR: 1.62 95% CI 1.24-2.12, p<0.001) and duration of thrombocytopenia (OR: 1.13 95% CI 1.06-1.20, p=0.001), duration of hospitalization (OR: 1.03 95% CI 1.01-1.05, p=0.004) were independently associated with the development of LOS. Multivariable Cox hazard modelling demonstrated that invasive ventilation (HR: 9.459, 95% CI 3.38-26.45, p<0.001), platelet transfusion (HR: 2.833 95% CI 1.54-5.20, p=0.001), lymphopenia (HR: 0.766, 95% CI 0.64-0.92, p=0.003), grade 2≥ of NEC (HR: 7.274, 95% CI 1.68-31.52, p=0.008), any type of haemorrhage (HR: 2.728, 95% CI 1.69-9.10, p=0.001), platelet nadir (HR: 0.972, 95% CI 0.96-0.98, p<0.001), MPV (HR: 0.805, 95% CI 0.66-0.98, p=0.032), and lymphopenia (HR: 0.745, 95% CI 0.63-0.89, p=0.001) independently predicted overall mortality.

Conclusion: Key findings indicate that larger platelet sizes, prolonged thrombocytopenia, and extended hospitalization are linked to late neonatal sepsis. Furthermore, lower platelet levels characterized by smaller platelet sizes and the necessity for platelet transfusions may also contribute to these adverse outcomes.

Kaynakça

  1. Eslami Z, Lookzadeh MH, Noorishadkam M, Hashemi A, Ghilian R, Pirdehghan A. Thrombocytopenia and Associated Factors in Neonates Admitted to NICU during Years 2010_2011. Iran J Ped Hematol Oncol. 2013;3(1):205-15.
  2. Ribeiro RP, Flor-DE-Lima F, Soares H, Rocha G, Guimarães H. Prevalence, risk factors and predictors of severity of neonatal thrombocytopenia in neonatal Intensive Care Units: a single center study. Minerva Pediatr (Torino). 2023;75(5):660-7. https://doi.org/10.23736/S0026-4946.19.05542-7
  3. Youssefian T, Drouin A, Massé JM, Guichard J, Cramer EM. Host defense role of platelets: engulfment of HIV and Staphylococcus aureus occurs in a specific subcellular compartment and is enhanced by platelet activation. Blood. 2002;99(11):4021-9. https://doi.org/10.1182/blood-2001-12-0191
  4. Wolff M, Handtke S, Palankar R, et al. Activated platelets kill Staphylococcus aureus, but not Streptococcus pneumoniae-The role of FcγRIIa and platelet factor 4/heparinantibodies. J Thromb Haemost. 2020;18(6):1459-68. https://doi.org/10.1111/jth.14814
  5. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017;390(10104):1770-80. https://doi.org/10.1016/S0140-6736(17)31002-4
  6. Guida JD, Kunig AM, Leef KH, McKenzie SE, Paul DA. Platelet count and sepsis in very low birth weight neonates: is there an organism-specific response? Pediatrics. 2003;111(6 Pt 1):1411-5. https://doi.org/10.1542/peds.111.6.1411
  7. Escobar GJ. The neonatal “sepsis work-up”: personal reflections on the development of an evidence-based approach toward newborn infections in a managed care organization. Pediatrics. 1999 Jan;103(1 Suppl E):360-73. https://doi.org/10.1542/peds.103.SE1.360
  8. Bhat MA, Bhat JI, Kawoosa MS, Ahmad SM, Ali SW. Organism-specific platelet response and factors affecting survival in thrombocytopenic very low birth weight babies with sepsis. J Perinatol. 2009;29(10):702-8. https://doi.org/10.1038/jp.2009.72
  9. Ahmad MS, Waheed A. Platelet counts, MPV and PDW in culture proven and probable neonatal sepsis and association of platelet counts with mortality rate. J Coll Physicians Surg Pak. 2014;24(5):340-4.
  10. Haque KN. Definitions of bloodstream infection in the newborn. Pediatr Crit Care Med. 2005;6(3 Suppl):S45-9. https://doi.org/10.1097/01.PCC.0000161946.73305.0A
  11. Vergnano S, Menson E, Kennea N, Embleton N, Russell AB, Watts T, Robinson MJ, Collinson A, Heath PT. Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed. 2011;96(1):F9-F14. https://doi.org/10.1136/adc.2009.178798
  12. Papile LA, Munsick-Bruno G, Schaefer A. Relationship of cerebral intraventricular hemorrhage and early childhood neurologic handicaps. J Pediatr. 1983;103(2):273-7. https://doi.org/10.1016/S0022-3476(83)80366-7
  13. Christensen RD, Henry E, Wiedmeier SE, et al. Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system. J Perinatol. 2006;26(6):348-53. https://doi.org/10.1038/sj.jp.7211509
  14. Baer VL, Lambert DK, Henry E, Christensen RD. Severe Thrombocytopenia in the NICU. Pediatrics. 2009;124(6):e1095-100. https://doi.org/10.1542/peds.2009-0582
  15. von Lindern JS, van den Bruele T, Lopriore E, Walther FJ. Thrombocytopenia in neonates and the risk of intraventricular hemorrhage: a retrospective cohort study. BMC Pediatr. 2011;11:16. https://doi.org/10.1186/1471-2431-11-16
  16. Resch E, Hinkas O, Urlesberger B, Resch B. Neonatal thrombocytopenia-causes and outcomes following platelet transfusions. Eur J Pediatr. 2018;177(7):1045-52. https://doi.org/10.1007/s00431-018-3153-7
  17. Christensen RD, Baer VL, Henry E, Snow GL, Butler A, Sola-Visner MC. Thrombocytopenia in Small-for-Gestational-Age Infants. Pediatrics. 2015;136(2):e361-70. https://doi.org/10.1542/peds.2014-4182
  18. Shah J, Jefferies AL, Yoon EW, Lee SK, Shah PS; Canadian Neonatal Network. Risk Factors and Outcomes of Late-Onset Bacterial Sepsis in Preterm Neonates Born at < 32 Weeks’ Gestation. Am J Perinatol. 2015;32(7):675-82. https://doi.org/10.1055/s-0034-1393936
  19. Ree IMC, Fustolo-Gunnink SF, Bekker V, Fijnvandraat KJ, Steggerda SJ, Lopriore E. Thrombocytopenia in neonatal sepsis: Incidence, severity and risk factors. PLoS One. 2017;12(10):e0185581. https://doi.org/10.1371/journal.pone.0185581
  20. Stanworth SJ, Clarke P, Watts T, et al. Prospective, observational study of outcomes in neonates with severe thrombocytopenia. Pediatrics. 2009;124(5):e826-34. https://doi.org/10.1542/peds.2009-0332
  21. Ghimire S, Ravi S, Budhathoki R, et al. Current understanding and future implications of sepsis-induced thrombocytopenia. Eur J Haematol. 2021;106(3):301-5. https://doi.org/10.1111/ejh.13549
  22. Christensen RD, Henry E, Del Vecchio A. Thrombocytosis and thrombocytopenia in the NICU: incidence, mechanisms and treatments. J Matern Fetal Neonatal Med. 2012;25 Suppl 4:15-7. https://doi.org/10.3109/14767058.2012.715027
  23. Wang J, Wang Z, Zhang M, Lou Z, Deng J, Li Q. Diagnostic value of mean platelet volume for neonatal sepsis: A systematic review and meta-analysis. Medicine (Baltimore). 2020;99(32):e21649. https://doi.org/10.1097/MD.0000000000021649
  24. Omran A, Sobh H, Abdalla MO, El-Sharkawy S, Rezk AR, Khashana A. Salivary and Serum Interleukin-10, C-Reactive Protein, Mean Platelet Volume, and CRP/MPV Ratio in the Diagnosis of Late-Onset Neonatal Sepsis in Full-Term Neonates. J Immunol Res. 2021;2021:4884537. https://doi.org/10.1155/2021/4884537
  25. Milas GP, Karageorgiou V, Bellos I. Mean platelet volume and neonatal sepsis: a systematic review and meta-analysis of diagnostic accuracy. J Matern Fetal Neonatal Med. 2022;35(25):5324-36. https://doi.org/10.1080/14767058.2021.1879039
  26. Estcourt LJ. Platelet transfusion thresholds in premature neonates (PlaNeT-2 trial). Transfus Med. 2019;29(1):20-2. https://doi.org/10.1111/tme.12587
  27. Chen C, Wu S, Chen J,et al. Evaluation of the Association of Platelet Count, Mean Platelet Volume, and Platelet Transfusion With Intraventricular Hemorrhage and Death Among Preterm Infants. JAMA Netw Open. 2022;5(10):e2237588. https://doi.org/10.1001/jamanetworkopen.2022.37588
  28. Bolat F, Kılıç SÇ, Oflaz MB, et al. The prevalence and outcomes of thrombocytopenia in a neonatal intensive care unit: a three-year report. Pediatr Hematol Oncol. 2012;29(8):710-20. https://doi.org/10.3109/08880018.2012.725454

Telif hakkı ve lisans

Telif hakkı © 2026 Yazar(lar). Açık erişimli bu makale, orijinal çalışmaya uygun şekilde atıfta bulunulması koşuluyla, herhangi bir ortamda veya formatta sınırsız kullanım, dağıtım ve çoğaltmaya izin veren Creative Commons Atıf Lisansı (CC BY) altında dağıtılmıştır.

Nasıl atıf yapılır

1.
Yaprak D, Mısırlıgil M, Saygılı Karagöl B, Dumlupınar E. Platelet indices as predictors of late-onset sepsis and mortality in thrombocytopenic neonates: A retrospective cohort study. Turk J Pediatr Dis. 2026;Early View:1-8. https://doi.org/10.12956/TJPD.2026.1319