Evaluation and treatment of thrombocytopenia in the neonatal intensive care unit

Phlebotomy‐induced anaemia excepted, thrombocytopenia is the most common haematological abnormality in neonatal intensive care unit (NICU) patients. Roughly one‐quarter of all NICU patients and half of all sick preterm neonates develop thrombocytopenia. Whereas a large number of varied precipitating...

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Veröffentlicht in:Acta Paediatrica 2002-09, Vol.91 (s438), p.74-81
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description Phlebotomy‐induced anaemia excepted, thrombocytopenia is the most common haematological abnormality in neonatal intensive care unit (NICU) patients. Roughly one‐quarter of all NICU patients and half of all sick preterm neonates develop thrombocytopenia. Whereas a large number of varied precipitating conditions has been identified, early‐onset thrombocytopenia (>72 h) is most commonly associated with fetomaternal conditions complicated by placental insufficiency and/or fetal hypoxia, e.g. maternal pre‐eclampsia and fetal intrauterine growth restriction. The resulting neonatal thrombocytopenia is usually mild to moderate, resolves spontaneously and requires no specific therapy. Deviation from this pattern of thrombocytopenia suggests the presence of more significant precipitating conditions. The most important of these are the immune thrombocytopenias, and every NICU should develop investigation and treatment protocols to manage these cases promptly and avoid unnecessary risk of haemorrhage. In contrast, late‐onset thrombocytopenia (>72 h) is almost always associated with sepsis or necrotizing enterocolitis and the associated thrombocytopenia is severe, prolonged and often requires treatment by platelet transfusion. Unfortunately, evidence‐based guidelines for platelet transfusion therapy in NICU patients are currently unavailable, making it difficult to define widely accepted thresholds for transfusion and leading to a significant variation in transfusion practice between centres. Conclusion: While improving this situation remains a pressing need, the growing evidence that impaired megakaryocytopoiesis and platelet production are major contributors to many neonatal thrombocytopenias suggests that recombinant haemopoietic growth factors, including thrombopoietin and interleukin‐11, may be useful future therapies to ameliorate neonatal thrombocytopenia.
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Roughly one‐quarter of all NICU patients and half of all sick preterm neonates develop thrombocytopenia. Whereas a large number of varied precipitating conditions has been identified, early‐onset thrombocytopenia (&gt;72 h) is most commonly associated with fetomaternal conditions complicated by placental insufficiency and/or fetal hypoxia, e.g. maternal pre‐eclampsia and fetal intrauterine growth restriction. The resulting neonatal thrombocytopenia is usually mild to moderate, resolves spontaneously and requires no specific therapy. Deviation from this pattern of thrombocytopenia suggests the presence of more significant precipitating conditions. The most important of these are the immune thrombocytopenias, and every NICU should develop investigation and treatment protocols to manage these cases promptly and avoid unnecessary risk of haemorrhage. In contrast, late‐onset thrombocytopenia (&gt;72 h) is almost always associated with sepsis or necrotizing enterocolitis and the associated thrombocytopenia is severe, prolonged and often requires treatment by platelet transfusion. Unfortunately, evidence‐based guidelines for platelet transfusion therapy in NICU patients are currently unavailable, making it difficult to define widely accepted thresholds for transfusion and leading to a significant variation in transfusion practice between centres. Conclusion: While improving this situation remains a pressing need, the growing evidence that impaired megakaryocytopoiesis and platelet production are major contributors to many neonatal thrombocytopenias suggests that recombinant haemopoietic growth factors, including thrombopoietin and interleukin‐11, may be useful future therapies to ameliorate neonatal thrombocytopenia.</description><identifier>ISSN: 0803-5253</identifier><identifier>ISSN: 0803-5326</identifier><identifier>EISSN: 1651-2227</identifier><identifier>DOI: 10.1111/j.1651-2227.2002.tb02908.x</identifier><identifier>PMID: 12477267</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Female ; Humans ; Incidence ; Infant, Newborn ; Intensive Care Units, Neonatal ; Interleukin-11 ; Interleukin-11 - therapeutic use ; Male ; neonatal ; Platelet Count ; Platelet Transfusion ; Prognosis ; Risk Assessment ; Severity of Illness Index ; Survival Rate ; thrombocytopenia ; Thrombocytopenia - diagnosis ; Thrombocytopenia - embryology ; Thrombocytopenia - epidemiology ; Thrombocytopenia - therapy ; thrombopoietin ; Thrombopoietin - therapeutic use ; transfusion ; Treatment Outcome</subject><ispartof>Acta Paediatrica, 2002-09, Vol.91 (s438), p.74-81</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3224-57a0a5f4b90ab2c0fc8dba210aa6a458eef2e42b7c4926408d67d6774965b15b3</citedby><cites>FETCH-LOGICAL-c3224-57a0a5f4b90ab2c0fc8dba210aa6a458eef2e42b7c4926408d67d6774965b15b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1651-2227.2002.tb02908.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1651-2227.2002.tb02908.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12477267$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Murray, NA</creatorcontrib><title>Evaluation and treatment of thrombocytopenia in the neonatal intensive care unit</title><title>Acta Paediatrica</title><addtitle>Acta Paediatr Suppl</addtitle><description>Phlebotomy‐induced anaemia excepted, thrombocytopenia is the most common haematological abnormality in neonatal intensive care unit (NICU) patients. Roughly one‐quarter of all NICU patients and half of all sick preterm neonates develop thrombocytopenia. Whereas a large number of varied precipitating conditions has been identified, early‐onset thrombocytopenia (&gt;72 h) is most commonly associated with fetomaternal conditions complicated by placental insufficiency and/or fetal hypoxia, e.g. maternal pre‐eclampsia and fetal intrauterine growth restriction. The resulting neonatal thrombocytopenia is usually mild to moderate, resolves spontaneously and requires no specific therapy. Deviation from this pattern of thrombocytopenia suggests the presence of more significant precipitating conditions. The most important of these are the immune thrombocytopenias, and every NICU should develop investigation and treatment protocols to manage these cases promptly and avoid unnecessary risk of haemorrhage. In contrast, late‐onset thrombocytopenia (&gt;72 h) is almost always associated with sepsis or necrotizing enterocolitis and the associated thrombocytopenia is severe, prolonged and often requires treatment by platelet transfusion. Unfortunately, evidence‐based guidelines for platelet transfusion therapy in NICU patients are currently unavailable, making it difficult to define widely accepted thresholds for transfusion and leading to a significant variation in transfusion practice between centres. 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Roughly one‐quarter of all NICU patients and half of all sick preterm neonates develop thrombocytopenia. Whereas a large number of varied precipitating conditions has been identified, early‐onset thrombocytopenia (&gt;72 h) is most commonly associated with fetomaternal conditions complicated by placental insufficiency and/or fetal hypoxia, e.g. maternal pre‐eclampsia and fetal intrauterine growth restriction. The resulting neonatal thrombocytopenia is usually mild to moderate, resolves spontaneously and requires no specific therapy. Deviation from this pattern of thrombocytopenia suggests the presence of more significant precipitating conditions. The most important of these are the immune thrombocytopenias, and every NICU should develop investigation and treatment protocols to manage these cases promptly and avoid unnecessary risk of haemorrhage. In contrast, late‐onset thrombocytopenia (&gt;72 h) is almost always associated with sepsis or necrotizing enterocolitis and the associated thrombocytopenia is severe, prolonged and often requires treatment by platelet transfusion. Unfortunately, evidence‐based guidelines for platelet transfusion therapy in NICU patients are currently unavailable, making it difficult to define widely accepted thresholds for transfusion and leading to a significant variation in transfusion practice between centres. Conclusion: While improving this situation remains a pressing need, the growing evidence that impaired megakaryocytopoiesis and platelet production are major contributors to many neonatal thrombocytopenias suggests that recombinant haemopoietic growth factors, including thrombopoietin and interleukin‐11, may be useful future therapies to ameliorate neonatal thrombocytopenia.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>12477267</pmid><doi>10.1111/j.1651-2227.2002.tb02908.x</doi><tpages>8</tpages></addata></record>
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subjects Female
Humans
Incidence
Infant, Newborn
Intensive Care Units, Neonatal
Interleukin-11
Interleukin-11 - therapeutic use
Male
neonatal
Platelet Count
Platelet Transfusion
Prognosis
Risk Assessment
Severity of Illness Index
Survival Rate
thrombocytopenia
Thrombocytopenia - diagnosis
Thrombocytopenia - embryology
Thrombocytopenia - epidemiology
Thrombocytopenia - therapy
thrombopoietin
Thrombopoietin - therapeutic use
transfusion
Treatment Outcome
title Evaluation and treatment of thrombocytopenia in the neonatal intensive care unit
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