Sepsis and Thrombocytopenia

Sepsis and Thrombocytopenia

Bhat MA, Bhat JI, Kawoosa MS, et al. Organism-specific platelet response and factors affecting survival in thrombocytopenic very low birth weight babies with sepsis. J Perinatol (Oct 2009); 29, 702–708. Full Text | PDF.

Objective: To study organism-specific platelet response and factors affecting survival in thrombocytopenic very low birth weight (VLBW) babies with sepsis.

Study Design: Very low birth weight babies (birth weight <1500 g) admitted to a single level-three intensive care unit from January 2000 to December 2005 were prospectively evaluated for sepsis by rapid screen test, blood counts and blood culture. In thrombocytopenic babies, organism-specific platelet response and its effect on various platelet parameters were evaluated. In addition, morbidity, mortality and factors affecting survival were studied.

Result: Sepsis was diagnosed in 230 of 620 (37%) patients. Gram-positive sepsis occurred in 20% (46/230), Gram-negative in 71% (164/230) and fungal in 8.6% (20/230) of patients. Thrombocytopenia was observed in 67% (155/230) of babies. The frequency and duration of thrombocytopenia were more with Gram-negative and fungal infections. The incidence of persistent bacteremia, multiorgan failure and death was more in thrombocytopenic neonates (P<0.01). The incidence of multiorgan failure and death was directly related to the duration of thrombocytopenia. On multiple logistic regression analysis, poor prognostic factors include a high SNAP score at admission, a severe drop in platelet count at onset of sepsis, a low platelet nadir, a prolonged duration of thrombocytopenia, a need for platelet transfusion, less number of days off ventilation and a prolonged stay in the hospital.

Conclusion: In thrombocytopenic VLBW babies with sepsis, organism-specific platelet response is seen. In addition, persistent bacteremia, multiorgan failure and death are more in these babies, and survival decreases with the increased severity and duration of thrombocytopenia, with prolonged ventilation and increased need for platelet transfusions

Comments: This study was done in India where gram negative and fungal sepsis are much more prevalent than in most NICUs in the United States. Coagulase-negative Staph infections occurred in only 8% of septic babies, and there was no cases or Group B Strep sepsis. In this study, about 2/3 of septic infants had thrombocytopenia. Low platelets were significantly more common with gram negative or fungal infections, than with gram positive sepsis. Septic infants with low platelet counts had a higher incidence of persistent bacteremia and higher mortality. It would be interesting to see if these results could be replicated in the United States. It could influence the selection of empirical antibiotic therapy, and decisions about whether to remove catheters as soon as infection is diagnosed. For a review of studies about the need to remove central catheters in babies with positive blood cultures, see 1-031, 1-032, and 2-027. ABK

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