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Most major bleeds in preterm infants occur in the absence of severe thrombocytopenia: an observational cohort study
  1. Hilde van der Staaij1,2,3,4,
  2. Nadine M A Hooiveld1,2,
  3. Camila Caram-Deelder2,
  4. Suzanne F Fustolo-Gunnink1,3,4,5,
  5. Karin Fijnvandraat3,4,
  6. Sylke J Steggerda1,
  7. Linda S de Vries1,
  8. Johanna G van der Bom2,
  9. Enrico Lopriore1
  1. 1 Department of Paediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
  2. 2 Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
  3. 3 Sanquin Research & Lab Services, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
  4. 4 Department of Paediatric Haematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  5. 5 Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Dr Hilde van der Staaij; h.van_der_staaij{at}lumc.nl

Abstract

Objective To describe the incidence of major bleeds according to different platelet counts in very preterm infants, and to explore whether this association is influenced by other risk factors for bleeding.

Design Observational cohort study.

Setting A Dutch tertiary care neonatal intensive care unit.

Patients All consecutive infants with a gestational age at birth <32 weeks admitted between January 2004 and July 2022.

Exposure Infants were stratified into nine groups based on their nadir platelet count (×109/L) during admission (<10, 10–24, 25–49, 50–99, 100–149, 150–199, 200–249, 250–299 and ≥300), measured before the diagnosis of a major bleed and before any platelet transfusion was administered.

Main outcome measure Incidence of major bleeds during admission. Logistic regression analysis was used to quantify the relationship between nadir platelet count and incidence of major bleeds.

Results Among 2772 included infants, 224 (8%) developed a major bleed. Of the infants with a major bleed, 92% (206/224) had a nadir platelet count ≥50×109/L. The incidence of major bleeds was 8% among infants with and without severe thrombocytopenia (platelet count <50×109/L), 18/231 (95% CI 5 to 12) and 206/2541 (95% CI 7 to 9), respectively. Similarly, after adjustment for measured confounders, there was no notable association between nadir platelet counts below versus above 50×109/L and the occurrence of major bleeds (OR 1.09, 95% CI 0.61 to 1.94).

Conclusion In very preterm infants, the vast majority of major bleeds occur in infants without severe thrombocytopenia.

  • Intensive Care Units, Neonatal
  • Neonatology
  • Epidemiology
  • Paediatrics

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request by email to the corresponding and the senior author. The data are not publicly available due to ethical/privacy restrictions.

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request by email to the corresponding and the senior author. The data are not publicly available due to ethical/privacy restrictions.

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Footnotes

  • Contributors HvdS, CC-D, JGvB and EL contributed substantially to the planning, conceptualisation and methodological design of the study. NMAH, HvdS and CC-D contributed substantially to the data collection, data cleaning and data analysis. HvdS and NMAH wrote the first draft of the manuscript. EL, JGvB, CC-D, SG, KF, SJS and LSdV gave significant input on the interpretation of the data and critically reviewed and edited the work. HvdS is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.