How I diagnose and treat neonatal thrombocytopenia

Neonatal thrombocytopenia, defined as the presence of a circulating platelet count <150 x 10(9)/L, is a common abnormality in babies admitted to neonatal intensive care units. Thrombocytopenia that is typically mild and selflimiting often accompanies neonatal stress in scenarios such as premature delivery or intrauterine growth restriction. However, the differential diagnosis of neonatal thrombocytopenia is wide and includes potentially lifethreatening disorders, such as bacterial sepsis, viral infection, and necrotizing enterocolitis. Distinguishing these causes of thrombocytopenia from entities such as genetic thrombocytopenia and fetal and neonatal alloimmune thrombocytopenia is critical for the accurate quantitation of significant adverse events, such as intracranial bleeding, and for the selection of treatments, such as platelet transfusion. In this review, we focus on common differential diagnoses of neonatal thrombocytopenia and highlight how the landscape of diagnosis and management is changing with recent advances in genomic technology and the completion of pivotal clinical trials of platelet transfusion practice. Increasing evidence highlights the need for judicious and restrictive use of platelet transfusions in neonates.

Automated summary

Neonatal thrombocytopenia is a common abnormality in babies admitted to neonatal intensive care units, with various potential causes including bacterial sepsis, viral infection, and genetic disorders. Accurate diagnosis is crucial for assessing adverse events and selecting appropriate treatments, such as platelet transfusion. Recent advances in genomic technology and clinical trials have influenced the landscape of diagnosis and management, with an increasing emphasis on judicious and restricted use of platelet transfusions.