Thrombocytopenia in Late Onset Neonatal Sepsis and Its Relationship with Specific Organism in A Tertiary Care...

Late onset neonatal sepsis (LONS) is a common complication in the Neonatal Intensive Care Unit (NICU) especially in premature infants, in whom the clinical presentation can be subtle and nonspecific. Thrombocytopenia is an important complication of sepsis. The objective of the present study was to identify the organism-speci?c platelet response in neonate with culture proven LONS. In this retrospective study all the infants with blood culture positive LONS in the neonatal intensive care unit (NICU) at Square Hospitals Ltd., Dhaka, Bangladesh from January 2012 to June 2016 were included in this retrospective observational study. Multiple hemograms with platelet counts, blood culture which also revealed growth of fungus along with growth of bacterial organism were conducted. Duration of thrombocytopenia in relation to type of organism and mortality with respect to degree of thrombocytopenia were also studied. Out of 87 patients with culture-proven nosocomial sepsis, 59(67.8%) patients developed thrombocytopenia (platelet count <150×10⁹/l). In our study, Acinetobacter was the most frequently isolated organism (22/87; 25.3%) the incidence of thrombocytopenia was high among patients who had gram negative sepsis, concurrent bacterial and fungal sepsis (4/4, 100%) and also isolated fungal sepsis (11/11; 100%). The mean platelet count in Gram negative sepsis was significantly lower than gram positive infection (p<0.0001) and also in fungal sepsis in compares with gram positive bacterial causes of sepsis (p=0.0085). Also, the mean duration of thrombocytopenia in patients with Gram-positive sepsis was significantly less than that of both Gram-negative and fungal sepsis (p<0.0001). In this study, about 1.15% cases presented mild, 21.84% moderate and 36.78% severe thrombocytopenia. The mortality rate was higher in thrombocytopenic group. LONS sepsis is an important risk factor for thrombocytopenia in the NICU. Fungal and gram negative sepsis were frequently associated with a decreased platelet count. The mortality rate was higher in sepsis associated with thrombocytopenia.