Thrombocytopenia and neutropenia among extremely low birth weight neonates

Thrombocytopenia and neutropenia are common in the NICU, and might be over represented among extremely low birth weight neonates (ELBW, ≤1000g birth weight). However, little is known about these issues in the ELBW population, thus we performed cohort analyses of ELBW neonates in a multihospital healthcare system. Seventy-three percent of patients had one or more platelet counts ≤150,000/uL and 80% of these occurred during the first week. Thrombcytopenia was more common in the smallest patients; 85% in those £800g, 60% in 801-900g, and 53% in 901-1000g. Platelet transfusions were given to 62%, and >90% of these were for patients who were not bleeding. The mortality rate in those receiving platelet transfusions was twice that of those receiving none (p<0.01). Thirty-eight percent had neutropenia (<1000/uL). It persisted for <24 hrs in 57% and for 1 to 7.5 days in 43%. Most (74%) occurred in the first three days. It was more common among the smallest patients; 63% in those ≤500 g, 44% in 501 to 600 g, and 34% in 801-1000 g. IVIG was given to 28%, and all were given according to guidelines. rG-CSF was given to 13% and 69% were given according to guidelines. Neither the presence of neutropenia nor the severity correlated with mortality rate. Much remains to be discovered about the etiology and best treatments of thrombocytopenia and neutropenia among ELBW neonates.