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Platelet Counts and Patent Ductus Arteriosus in Preterm Infants: An Updated Systematic Review and Meta-Analysis
Gema González-Luis1, Stefano Ghiradello2, Pilar Bas-Suárez3
1Department of Neonatology, Complejo Hospitalario Universitario Insular Materno-Infantil (CHUIMI) de Canarias, Las Palmas de Gran Canaria, Spain.
Insights
Low platelet counts in newborns are linked to a higher risk of patent ductus arteriosus (PDA). This updated meta-analysis confirms this association and highlights other platelet parameters like platelet mass and distribution width as potential indicators for PDA risk in preterm infants.
Area of Science:
- Neonatalogy
- Hematology
- Pediatric Cardiology
Background:
- A previous meta-analysis in 2015 indicated a link between low neonatal platelet counts and patent ductus arteriosus (PDA) risk.
- This study aimed to update the meta-analysis by incorporating newer research and examining additional platelet parameters beyond just count.
Approach:
- Conducted a comprehensive search of PubMed/Medline and Embase databases.
- Performed random-effects meta-analyses to calculate risk ratios (RR) and differences in means (DM) with 95% confidence intervals (CI).
- Included data from 31 studies encompassing 7,638 preterm infants.
Key Points:
- Low platelet counts (<150 × 10^9/L and <100 × 10^9/L) were significantly associated with an increased risk of any PDA and hemodynamically significant PDA (hsPDA).
- Infants with hsPDA exhibited significantly lower mean platelet counts and platelet mass, along with a higher platelet distribution width (PDW).
- No significant association was found between mean platelet volume (MPV) and hsPDA.
Conclusions:
- This updated meta-analysis provides robust evidence strengthening the association between low platelet counts and PDA/hsPDA in preterm infants.
- Platelet mass and PDW emerge as other platelet parameters associated with hsPDA risk.
- The study suggests that low platelet count might be a marker of immaturity or clinical instability rather than a direct cause of PDA.
Abstract:
Background: A meta-analysis published in 2015 showed a significant association between low platelet counts in the first day(s) of life and risk of patent ductus arteriosus (PDA). The meta-analysis pooled data from 11 studies cohorts (3,479 preterm infants). Objective: To update the meta-analysis by adding new studies on the topic and including other platelet parameters different from platelet counts. Methods: PubMed/Medline and Embase databases were searched. Random-effects risk ratios (RR) and differences in means (DM) and 95% confidence intervals (CI) were calculated. Results: We included 31 studies (7,638 infants). Meta-analysis showed that the risk of developing any PDA was significantly associated with platelet counts<150 × 109/L (11 studies, RR 1.58, 95% CI 1.28 to 1.95), and <100 x 109/L (7 studies, RR 1.61, 95% CI 1.14 to 2.28), but not <50 x 109/L (4 studies, RR 1.34, 95% CI 0.77 to 2.32). Risk of developing hemodynamically significant PDA (hsPDA) was significantly associated with platelet counts<150 x 109/L (12 studies, RR 1.33, 95% CI 1.09 to 1.63), and <100 x 109/L (7 studies, RR 1.39, 95% CI 1.06 to 1.82), but not <50 x 109/L (6 studies, RR 1.24, 95% CI 0.86 to 1.79). Infants with hsPDA had significantly lower mean platelet counts (19 studies, DM 22.0 x 109, 95% CI 14.9 to 29.1) and platelet mass (11 studies, DM 214.4, 95% CI 131.2 to 297.5) and significantly higher platelet distribution width (PDW, 9 studies, DM -0.53, 95% CI -1.01 to -0.05) than infants without hsPDA. Meta-analysis could not demonstrate significant differences in mean platelet volume (MPV). Conclusion: Compared to the previous analysis, this updated meta-analysis included 21 additional studies that provide stronger evidence of the association between low platelet counts and PDA/hsPDA. Other platelet parameters such as platelet mass and PDW are also associated with hsPDA risk. However, the low number of platelets may be an epiphenomenon associated with the maturity and clinical stability of preterm infants rather than a contributing factor in the pathogenesis of PDA.
