Prevalence and Course of Thrombocytopenia in Culture Positive and Culture Negative Neonatal Sepsis
Keywords:
Thrombocytopenia, Culture Positive Sepsis, Culture Negative Sepsis
Abstract
Introduction: Neonatal Sepsis is commonly associated with thrombocytopenia.
Objective: To assess the prevalence and course of thrombocytopenia in culture positive and culture negative neonatal sepsis in comparison to normal newborns.
Methods: This is a retrospective case analysis of 533 neonates between January-2012 to December-2014. The parameters examined were Baseline Platelet Count, Change In Platelet Count, (Baseline Platelet Count- Change In Platelet Count)/ Baseline Platelet Count, Platelet Nadir, Incidence, Duration & Severity of Thrombocytopenia.
Statistical Analysis: All data were collected in validated preformatted proforma sheet & analysed using appropriate statistical methods.
Results: Among 533 neonates, 21.2% had Culture negative sepsis, 9.75% had culture positive sepsis & 69.04% had no sepsis. The prevalence of early onset sepsis was 17.44% & late onset sepsis was 13.50%. About 24.76% babies had thrombocytopenia; 9.56% had mild thrombocytopenia, 10.13% had moderate & 5.06% had severe thrombocytopenia. Late onset sepsis was associated with significant thrombocytopenia. Culture positive sepsis had significant drop in platelets with lower platelet nadir, higher incidence, more severe & prolonged thrombocytopenia compared to culture negative sepsis & normal neonates.
Conclusion: There are quantitative differences in the platelet response to neonatal sepsis, particularly to culture positive sepsis. Hematological changes in platelet count induced by culture proven and culture negative neonatal sepsis can be used to make an early diagnosis and prompt management of neonatal sepsis.
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References
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2. Sucilathangam G. Early Diagnostic Markers for Neonatal Sepsis: Comparing Procalcitonin and CReactive Protein. J Clin Diagn Res. 2012 May (Suppl-2), Vol-6(4): 627- 631.
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4. Storm W. Use of thrombocytopenia for the early identification of sepsis in critically ill newborns. Acta Paediatr, Acad Sci Hung. 1982(23):349–355.
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11. Jack D Guida, Anette M. Kunig, Kathleen H Leef, Steven E McKenzie, David A. Paul. Platelet Count and Sepsis in Very Low Birth Weight Neonates: Is There an Organism-Specific Response? Pediatrics 2003;(111):1411–1415.
12. Bizzarro MJ, Dembry LM, Baltimore RS. Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics. 2008;(121):689–696.
13. Van den Hoogen A, Gerards LJ, Verboon-Maciolek MA. Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents. Neonatology. 2010;(97):22–28.
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24. Lee YH, Kim SW, Kim MH and Choi YS. Predictive factors and its usefulness in early diagnosis of neonatal sepsis. J Kor Social Neonatol;(1997);4(2)195-204.
25. Karthikeyan G, Premkumar K. Neonatal sepsis: Staphylococcus aureus as the predominant pathogen. Indian J Paediatr 2001;(68):715-717.
26. Deepa S, Manjunatha,Venkatesha D. Screening cord blood is a better diagnosing method for early onset neonatal septicemia; Indian J Med Res Pharma Sci,October 2014;1(5)ISSN:2349 – 5340.
27. A.C. Buch, V. Srivastava, Harsh Kumar, P.S.Jadhav. Evaluation of haematological profile in early diagnosis of clinically suspected cases of neonatal sepsis;Int J Basic App Med Sci;ISSN:2277-2103;(2011);Vol.1(1) September-December.
28. Tallur SS, Kasturi AV, Nadgir SD, Krishna BVS. A clinico-bacteriological study of neonatal septicaemia in Hubli. Indian J Paediatr 2000;(67):169-74.
29. Sidra Younis, Muhammad Ali Sheikh, Amjad Ali Raza.Diagnostic Accuracy of C-Reactive Protein in Neonatal Sepsis; J Bioresource Management;Volume 1(1)Article 1
30. Mishra UK, Jacobs SE, Doyle LW, Garland SM. Newer approaches to the diagnosis of early onset neonatal sepsis. Arch Dis Child Fetal Neonatal Ed 2006, 91(3):F208-212.
31. Kohli-Kochhar R, Omuse G, Revathi G: A ten-year review of neonatal bloodstream infections in a tertiary private hospital in Kenya. J infect developing countries; (2011), 5(11). [PubMed]
32. Roberts I, Murray NA. Neonatal thrombocytopenia. Semin Fetal Neonatal Med. 2008;13(4):256-64.
33. Roberts I, Stanworth S, Murray NA. Thrombocytopenia in the neonate. Blood Rev. 2008;22(4):173-86. [PubMed]
34. Roberts IA, Murray NA. Neonatal thrombocytopenia: new insights into pathogenesis and implications for clinical management. Curr Opin Pediatr. 2001;13:16–21.
35. Castle V, Andrew M, Kelton J. Frequency and mechanism of neonatal thrombocytopenia. J Pediatr (1986);108:749–55.
36. Mehta P, Rohitkumar V, Neumann L, et al. Thrombocytopenia in the high risk infant. J Pediatr (1980);(97):791–4.
37. Abdalla Alshorman. The Effect of Neonatal Sepsis on Platelet Count and their Indices et al. 83 J Med J 2008; June:Vol. 42. [PubMed]
38. Aman I, Hassan KA, Ahmad TM. The study of thrombocytopenia in sick neonates. J Coll Physicians Surg Pak; 2004 May;14(5):282-5. [PubMed]
39. Murray NA, Roberts IAG. Circulating megakaryocytes and their progenitors in early thrombocytopenia in preterm neonates. Pediatr Res 1996;(40):112–19.
40. Gupta AK, Kumari S, Singhal A, Bahl A. Neonatal thrombocytopenia and platelets transfusion. Asian J Transfus Sci. 2012;6(2):161-4.
41. Kyoung Hee Choi , Sung Soo Rim , Byung Min Moon ,Ki Bok Kim. Study on platelet counts and indices in neonates ; ;Korean J Pediatr (1996) March;39(3) :338-345.
42. Mannan MA, Shahidullah M, Noor MK, Islam F, Alo D, Begum NA. Utility of creactive protein and hematological parameters in the detection of neonatal sepsis. Mymensingh Med J; 2010;(19):259-63. [PubMed]
43. Torkaman M, Afsharpaiman S H, Hoseini M J , Moradi M. Platelet count and neonatal sepsis: a high prevalence of Enterobacter spp. Sing Med J, 2009, 50(5): 482-485. [PubMed]
44. Tiago de Oliveira Boechat, Maria Fernanda Baylão Bueno da Silveira, Wilian Faviere, Gerson Luiz de Macedo.Thrombocytopenia in sepsis: an important prognosis factor; Revista Brasileira de Terapia Intensiva; ISSN 0103-507XRev. bras. ter. intensiva vol.24 (1)Jan./Mar. 2012. [PubMed]
45. Charoo BA, Iqbal JI, Iqbal Q, Mushtaq S, Bhat AW, Nawaz I. Nosocomial sepsis induced late onset thrombocytopenia in a neonatal tertiary care unit:a prospective study. Hematol Oncol Stem Cell Ther 2009;(2):349-53. [PubMed]
46. Christensen RD, Henry E, Del Vecchio A. Thrombocytosis and thrombocytopenia in the NICU: incidence, mechanisms and treatments. J Matern Fetal Neonatal Med. 2012 Oct;25(4):15-7. [PubMed]
47. Murray NA, Howarth LJ, McCloy MP. Platelet transfusion in the management of severe thrombocytopenia in neonatal intensive care unit patients.Transfus Med 2002;(12):35–41. [PubMed]
48. Sainio S, Jarvenpaa A-S, Renlund M. Thrombocytopenia in term infants: a population-based study. Obstet Gynecol 2000;(95):441–6. [PubMed]
49. de Moerloose P, Boehlen F, Extermann P. Neonatal thrombocytopenia: incidence and characterization of maternal antiplatelet antibodies by MAIPA assay. Br J Haematol 1998;(100):735–40.
50. Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med 1993;329:1463–6. [PubMed]
51. Uhrynowska M, Niznikowska-Marks M, Zupanska B. Neonatal and maternal thrombocytopenia: incidence and immune background. Eur J Haematol 2000;(64):42–6. [PubMed]
52. Dreyfus M, Kaplan C, Verdy E. Frequency of immune thrombocytopenia in newborns:a prospective study. Immune Thrombocytopenia Working Group. Blood 1997;(89):4402–6. [PubMed]
2. Sucilathangam G. Early Diagnostic Markers for Neonatal Sepsis: Comparing Procalcitonin and CReactive Protein. J Clin Diagn Res. 2012 May (Suppl-2), Vol-6(4): 627- 631.
3. Modanlou HD, Ortiz OB. Thrombocytopenia in neonatal infection. Clin Pediatr (Phila). 1981;20:402–407.
4. Storm W. Use of thrombocytopenia for the early identification of sepsis in critically ill newborns. Acta Paediatr, Acad Sci Hung. 1982(23):349–355.
5. Zaccheaus A Jeremiah, Justina E Oburu. Pattern and prevalence of neonatal thrombocytopenia in Port Harcourt, Nigeria;Pathol Lab Med Int. 2010:(2) 27–31.
6. Marzban A1, Samaee H, Mosavinasab N. Changing trend of empirical antibiotic regimen: experience of two studies at different periods in a neonatal intensive care unit in Tehran, Iran. Acta Med Iran. 2010 Sep-Oct; 48(5):312-5.
7. Khalessi N , Khosravi N , Sanii S , Zareh Mehrjerdi F. The Prevalence and Risk Factors for Neonatal Thrombocytopenia among Newborns Admitted to Intensive Care Unit of Aliasghar Children’s Hospital ; Ir J Blood And Cancer; Vol 5(2);2013.
8. Roberts I, Murray NA. Neonatal thrombocytopenia. Semin Fetal Neonatal Med. 2008;13(4):256-64.
9. Beiner ME, Simchen MJ, Sivan E, Chetrit A, Kuint J, Schiff E. Risk factors for neonatal thrombocytopenia in preterm infants. Am J Perinatol. 2003;20(1):49-54. [PubMed]
10. Bolat F, Kılıç SÇ, Oflaz MB, Gülhan E, Kaya A, Güven AS. The prevalence and outcomes of thrombocytopenia in a neonatal intensive care unit: a three-year report. Pediatr Hematol Oncol 09/2012; 29(8):710-20.
11. Jack D Guida, Anette M. Kunig, Kathleen H Leef, Steven E McKenzie, David A. Paul. Platelet Count and Sepsis in Very Low Birth Weight Neonates: Is There an Organism-Specific Response? Pediatrics 2003;(111):1411–1415.
12. Bizzarro MJ, Dembry LM, Baltimore RS. Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics. 2008;(121):689–696.
13. Van den Hoogen A, Gerards LJ, Verboon-Maciolek MA. Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents. Neonatology. 2010;(97):22–28.
14. Sharma A, Krishna Kutty CV, Sabharwal U, Sushila and Mohan H. Evaluation of sepsis screen for diagnosis of neonatal septicemia. Indian J Pediatr (1993);60(4);559-563. [PubMed]
15. Ramesh Bhat Y, Lincy P. Early Onset of Neonatal Sepsis: Analysis of the Risk Factors and the Bacterial Isolates by Using the BacT Alert System; J Clin Diagn Res. 2011-November(Suppl-2),Vol-5(7):1385-1388.
16. Ahmed NU, Chowdhury MA, Hoque M, Darmstadt GL. The clinical and bacteriological profile of neonatal septicemia in a tertiary level paediatric hospital in Bangladesh. Indian Paediatr 2002;(39):1034- 1039.
17. Baltimore RS, Huie SM, Meek JI, Schuchat A, O’Brein KL. Early-onset of neonatal sepsis in the era of group B Streptococcal prevention. Paediatrics 2001;(108):1094-98. [PubMed]
18. Gladstone IM, Ehrenkranz RA, Edberg SC, Baltimore RS. A ten-year review of neonatal sepsis and comparison with a previous fifty-year experience. Paediatr Infect Dis J;1990;(9):819–25.
19. d’Haens EJ, Roell-Schorer EAM, van-Elzakker EPM, de-Beaufort AJ, Sprij AJ. Clinical availability of neonatal blood culture results at 48 hours. J Neonatol -Perinatal Med 2009;(2):109-13. [PubMed]
20. Qazi Iqbalab, Charoo Bashira, Sheikh Mushtaqa, Asif Ahmada, Akhtar Rasool Babaa. Thrombocytopenia and other hematological parameters in culture positive neonatal sepsis and their impact; India J Pediatr Infectious Dis 8 (2013) 25–29. [PubMed]
21. Kayange N, Kamugisha E, Mwizamholya DL, Jeremiah S and Mshana SE. Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza-Tanzania. BMC Pediatr,;(10)39. [PubMed]
22. Anil K Gupta, Sudarshan Kumari, Abhishek Singhal, Aruna Bahl.Neonatal thrombocytopenia and platelets transfusion; Asian J Transfusion Sci, Vol.6(2),July-December(2012);161-164.
23. Hussein AB, Khaled MAR. CRP in neonate with suspected septicemia; Rawal Medical J;(20070;32(1)24-27. [PubMed]
24. Lee YH, Kim SW, Kim MH and Choi YS. Predictive factors and its usefulness in early diagnosis of neonatal sepsis. J Kor Social Neonatol;(1997);4(2)195-204.
25. Karthikeyan G, Premkumar K. Neonatal sepsis: Staphylococcus aureus as the predominant pathogen. Indian J Paediatr 2001;(68):715-717.
26. Deepa S, Manjunatha,Venkatesha D. Screening cord blood is a better diagnosing method for early onset neonatal septicemia; Indian J Med Res Pharma Sci,October 2014;1(5)ISSN:2349 – 5340.
27. A.C. Buch, V. Srivastava, Harsh Kumar, P.S.Jadhav. Evaluation of haematological profile in early diagnosis of clinically suspected cases of neonatal sepsis;Int J Basic App Med Sci;ISSN:2277-2103;(2011);Vol.1(1) September-December.
28. Tallur SS, Kasturi AV, Nadgir SD, Krishna BVS. A clinico-bacteriological study of neonatal septicaemia in Hubli. Indian J Paediatr 2000;(67):169-74.
29. Sidra Younis, Muhammad Ali Sheikh, Amjad Ali Raza.Diagnostic Accuracy of C-Reactive Protein in Neonatal Sepsis; J Bioresource Management;Volume 1(1)Article 1
30. Mishra UK, Jacobs SE, Doyle LW, Garland SM. Newer approaches to the diagnosis of early onset neonatal sepsis. Arch Dis Child Fetal Neonatal Ed 2006, 91(3):F208-212.
31. Kohli-Kochhar R, Omuse G, Revathi G: A ten-year review of neonatal bloodstream infections in a tertiary private hospital in Kenya. J infect developing countries; (2011), 5(11). [PubMed]
32. Roberts I, Murray NA. Neonatal thrombocytopenia. Semin Fetal Neonatal Med. 2008;13(4):256-64.
33. Roberts I, Stanworth S, Murray NA. Thrombocytopenia in the neonate. Blood Rev. 2008;22(4):173-86. [PubMed]
34. Roberts IA, Murray NA. Neonatal thrombocytopenia: new insights into pathogenesis and implications for clinical management. Curr Opin Pediatr. 2001;13:16–21.
35. Castle V, Andrew M, Kelton J. Frequency and mechanism of neonatal thrombocytopenia. J Pediatr (1986);108:749–55.
36. Mehta P, Rohitkumar V, Neumann L, et al. Thrombocytopenia in the high risk infant. J Pediatr (1980);(97):791–4.
37. Abdalla Alshorman. The Effect of Neonatal Sepsis on Platelet Count and their Indices et al. 83 J Med J 2008; June:Vol. 42. [PubMed]
38. Aman I, Hassan KA, Ahmad TM. The study of thrombocytopenia in sick neonates. J Coll Physicians Surg Pak; 2004 May;14(5):282-5. [PubMed]
39. Murray NA, Roberts IAG. Circulating megakaryocytes and their progenitors in early thrombocytopenia in preterm neonates. Pediatr Res 1996;(40):112–19.
40. Gupta AK, Kumari S, Singhal A, Bahl A. Neonatal thrombocytopenia and platelets transfusion. Asian J Transfus Sci. 2012;6(2):161-4.
41. Kyoung Hee Choi , Sung Soo Rim , Byung Min Moon ,Ki Bok Kim. Study on platelet counts and indices in neonates ; ;Korean J Pediatr (1996) March;39(3) :338-345.
42. Mannan MA, Shahidullah M, Noor MK, Islam F, Alo D, Begum NA. Utility of creactive protein and hematological parameters in the detection of neonatal sepsis. Mymensingh Med J; 2010;(19):259-63. [PubMed]
43. Torkaman M, Afsharpaiman S H, Hoseini M J , Moradi M. Platelet count and neonatal sepsis: a high prevalence of Enterobacter spp. Sing Med J, 2009, 50(5): 482-485. [PubMed]
44. Tiago de Oliveira Boechat, Maria Fernanda Baylão Bueno da Silveira, Wilian Faviere, Gerson Luiz de Macedo.Thrombocytopenia in sepsis: an important prognosis factor; Revista Brasileira de Terapia Intensiva; ISSN 0103-507XRev. bras. ter. intensiva vol.24 (1)Jan./Mar. 2012. [PubMed]
45. Charoo BA, Iqbal JI, Iqbal Q, Mushtaq S, Bhat AW, Nawaz I. Nosocomial sepsis induced late onset thrombocytopenia in a neonatal tertiary care unit:a prospective study. Hematol Oncol Stem Cell Ther 2009;(2):349-53. [PubMed]
46. Christensen RD, Henry E, Del Vecchio A. Thrombocytosis and thrombocytopenia in the NICU: incidence, mechanisms and treatments. J Matern Fetal Neonatal Med. 2012 Oct;25(4):15-7. [PubMed]
47. Murray NA, Howarth LJ, McCloy MP. Platelet transfusion in the management of severe thrombocytopenia in neonatal intensive care unit patients.Transfus Med 2002;(12):35–41. [PubMed]
48. Sainio S, Jarvenpaa A-S, Renlund M. Thrombocytopenia in term infants: a population-based study. Obstet Gynecol 2000;(95):441–6. [PubMed]
49. de Moerloose P, Boehlen F, Extermann P. Neonatal thrombocytopenia: incidence and characterization of maternal antiplatelet antibodies by MAIPA assay. Br J Haematol 1998;(100):735–40.
50. Burrows RF, Kelton JG. Fetal thrombocytopenia and its relation to maternal thrombocytopenia. N Engl J Med 1993;329:1463–6. [PubMed]
51. Uhrynowska M, Niznikowska-Marks M, Zupanska B. Neonatal and maternal thrombocytopenia: incidence and immune background. Eur J Haematol 2000;(64):42–6. [PubMed]
52. Dreyfus M, Kaplan C, Verdy E. Frequency of immune thrombocytopenia in newborns:a prospective study. Immune Thrombocytopenia Working Group. Blood 1997;(89):4402–6. [PubMed]
CITATION
DOI: 10.17511/ijpr.2014.i03.01
Published: 2014-12-31
How to Cite
Dr. Rabindran, Dr.Hemant Parakh, Dr.Ramesh J K, & Dr.Prashant Reddy. (2014). Prevalence and Course of Thrombocytopenia in Culture Positive and Culture Negative Neonatal Sepsis. Pediatric Review: International Journal of Pediatric Research, 1(3), 65-71. https://doi.org/10.17511/ijpr.2014.i03.01
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Copyright (c) 2014 Author (s). Published by Siddharth Health Research and Social Welfare Society
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