Fetus-Placenta-Newborn
Association of thrombocytopenia and delivery method with intraventricular hemorrhage among very-low-birth-weight infants☆,☆☆

https://doi.org/10.1067/mob.2002.118268Get rights and content

Abstract

Objectives: To investigate the significance of neonatal thrombocytopenia and delivery method on the incidence of intraventricular hemorrhage in infants weighing <1500 g. Study Design: A total of 1283 infants weighing <1500 g who were admitted to six neonatal intensive care units over 21 months were analyzed prospectively. Illness severity was measured by the Score for Neonatal Acute Physiology (SNAP). Results: Of the infants analyzed, 145 (11.3%) had thrombocytopenia (platelet count <100 × 109/L). The incidence of intraventricular hemorrhage was greater among infants with thrombocytopenia than among those without (44.8% vs 23.9%, P <.0001). Nonthrombocytopenic infants who were delivered vaginally had a higher incidence of intraventricular hemorrhage than those delivered via cesarean section (35.8% vs 15.9%, P <.0001). Thrombocytopenic infants who were delivered vaginally had the highest incidence of intraventricular hemorrhage (63.4% vs 37.5% for cesarean section, P =.005). Vaginal delivery and platelets < 50×109/L on day 1 were independent risk factors for intraventricular hemorrhage (OR 2.7, 95% CI 2.0-3.8 and OR 11.2, 95% CI 3.0-42.5, respectively). Conclusions: This multicenter study confirms that thrombocytopenia and intraventricular hemorrhage are not uncommon in neonates who weigh <1500 g, and that the incidence of intraventricular hemorrhage is higher in those thrombocytopenic infants delivered vaginally. (Am J Obstet Gynecol 2002;186:109-16.)

Section snippets

Study design

We performed a secondary analysis of data that were collected as part of a study of NICU outcomes. We prospectively abstracted medical charts of all VLBW infants (birth weights of <1500 g) who were admitted to six major regional NICUs during the 21 months from October 1, 1994 to June 30, 1996. Infants who were readmitted, stayed in the NICU for <24 hours, or who were born outside the study sites and were admitted after 24 hours of life were excluded from the study. Upon admission to the NICU,

Population

During the study period, 1572 very-low-birth-weight infants were admitted (initial admission) to one of the six NICUs. We excluded 83 cases (5.3%) from the analyses for the following reasons: the infant was not born at one of the study sites and was admitted after 24 hours of life (n = 18, 1.1%); the infant was transferred out of the NICU within 24 hours of admission (n = 18, 1.1%); or the medical chart was incomplete (n = 67, 4.3%). These exclusions resulted in an initial population base of

Comment

The prevalence of NT in the VLBW infant has been reported to be ~20%.1, 2 Our study has found that prevalence to be somewhat lower (14%). This low value is probably a result of our criterion for a low platelet count (<100 × 109/L), which is stricter than most and excludes mild NT. In addition, we reviewed platelet counts on days 1, 3, and 14 of life only; it is, therefore, probable that some transient NT was missed. The question of whether thrombocytopenia found on only one study day in this

Acknowledgements

We thank the co-investigators of the SNAP II Study Group at the participating sites: James E. Gray, MD, MS (Joint Program in Neonatology [Beth Israel, Brigham and Women's and Children's Hospital and Harvard Medical School], Boston, Mass), Francis Bednarek, MD (Memorial Health Care and University of Massachusetts, Worcester, Mass), Lewis P. Rubin, MD (Women and Infant's Hospital, Providence, RI), Bhavesh Shah, MD (Division of Neonatology, Baystate Medical Center, Springfield, Mass), Ivan D.

References (24)

  • WJ Morales

    Effect of intraventricular hemorrhage on the one-year mental and neurologic handicaps of the very low birth weight infant

    Obstet Gynecol

    (1987)
  • M O'Shea et al.

    Prenatal events and the risk of subependymal/intraventricular haemorrhage in very low birthweight infants

    Paediatr Perinat Epidemiol

    (1992)

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    ☆

    Funded by Agency for Healthcare Policy and Research grant RO1-HS07015.

    ☆☆

    Reprint requests: Henny H. Billett, MD, Division of Hematology, The Albert Einstein College of Medicine, 1300 Morris Park Ave, Ullmann 903, Bronx, NY 10461. E-mail: [email protected].

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