831 Patterns of Minor Bleeding in Neonates with Severe Thrombocytopenia: A Prospective Observational Study

Abstract

Background and aim: A prospective cross sectional observational study to determine incidence and pattern of minor bleeding in neonates with severe neonatal thrombocytopenia (SNT) defined as platelet count < 60 x10⁹/L.

Methods: Neonates admitted to seven UK tertiary neonatal units (March 2005 -November 2006) documented to have SNT were enrolled for daily data collection.

Results: 169 babies with SNT were enrolled for 2055 study days. 123 (73%) babies showed minor bleeding, 15 (9%) minor and major bleeds, 31 (18%) no evidence of bleeding. Bleeding as a percentage of study days occured with greatest frequency in extremely preterm infants: < 28 weeks, 44%; 28-34 weeks, 27%; >34 weeks, 28%. Neonates with early SNT (< 3 days) most commonly had hematuria (31%), oozing (20%) and/or nasogastric bleeding (17%). Neonates with late SNT(≥3 days) most commonly showed hematuria (42%), minor bleeding from the endotracheal tube (24%) and oozing (13%). Minor bleeding (bleeding days as a percentage of study days) with SNT was commoner in the first 10 days (50%) compared to >10 days (33%). Neonates with major bleeds did not show a higher incidence of minor bleeding events prior to the major haemorrhage. 41% of infants with nadir platelet counts ≤ 40 x10⁹/L had minor bleeding. At platelet counts >40 x10⁹/L 59% of infants had minor bleeding.

Conclusion: Minor bleeding and in particular hematuria is common in thrombocytopenic neonates and appears to inversely correlate with gestational age but not absolute platelet count.

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