Original Article
Journal of Perinatology (2005) 25, 14–20. doi:10.1038/sj.jp.7211180 Published online 4 November 2004
Severe Thrombocytopenia Predicts Outcome in Neonates with Necrotizing Enterocolitis
Alexander B Kenton MD1, Donough O'Donovan MD1, Darrell L Cass MD2, Michael A Helmrath MD2, E O'Brian Smith PhD3, Caraciolo J Fernandes MD1, Kimberly Washburn BSc2, Elizabeth K Weihe BSc1 and Mary L Brandt MD2
- 1Division of Neonatology (A.B.K., D.O'D., C.J.F., E.K.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- 2Division of Pediatric Surgery (D.L.C., M.A.H., K.W., M.L.B.), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- 3Department of Pediatrics-Nutrition (E.O'B.S.), Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
Correspondence: Mary L. Brandt, MD, Division of Pediatric Surgery, Texas Children's Hospital, 6701 Fannin, Suite 650, Houston, TX 77030, USA
Abstract
OBJECTIVE:
Necrotizing enterocolitis (NEC) is a common and serious gastrointestinal disorder that predominately affects premature infants. Few prognostic indices are available to guide physicians through the expected course of the disease. We hypothesized that the degree and timing of onset of severe thrombocytopenia (platelet count <100,000/mm3) would be a predictor of adverse outcome and an indication for surgical intervention in infants with NEC.
STUDY DESIGN:
The clinical presentation and outcome of all infants with Bell stage II or III NEC treated at Texas Children's Hospital between 1997 and 2001 were retrospectively reviewed. Patients were stratified into two groups based on the presence (Group1) or absence (Group 2) of severe thrombocytopenia (platelet count <100,000/mm3) within 3 days of a diagnosis of NEC. Differences between groups were compared using logistic regression to estimate adjusted odds ratios.
RESULTS:
A total of 91 infants met inclusion criteria (average birth weight 1288
135 g; average gestational age 29.03.0 weeks). Compared to infants in Group 2, infants in Group 1 were more premature (28.04.1 vs 30.04.2 weeks; p=0.02), more likely to have received postnatal steroids (42.5% vs 20.4%; p=0.02), and more likely to require laparotomy for gangrenous bowel (adjusted OR 16.33; p<0. 001). The presence of severe thrombocytopenia was also a predictor of mortality (adjusted OR 6.39; p=0.002) and NEC-related gastrointestinal complications including cholestatic liver disease and short bowel syndrome (adjusted OR 5.47; p=0.006).
CONCLUSION:
Severe thrombocytopenia within the first 3 days after a diagnosis of NEC suggests a higher likelihood of bowel gangrene, morbidity, and mortality. Prospective studies of infants with early and severe thrombocytopenia may help determine the optimal timing of laparotomy in infants with NEC.
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