Prevalence and severity of thrombocytopenia in blood culture proven neonatal sepsis: A prospective study

Background: The reported prevalence and pattern of thrombocytopenia in neonatal sepsis vary widely. Objectives: We aimed to determine the prevalence and severity of thrombocytopenia in blood culture proven neonatal sepsis. Methods: The study was conducted in a University hospital by recruiting neonates with sepsis in whom blood culture had grown microorganisms. The initial platelet count refers to the one obtained at the same time as the positive blood culture. Platelet counts were monitored 12 - 24 hourly. Thrombocytopenia was considered mild if between 50,000/mm³ and 150,000/mm³, moderate if between 20,000/mm³ and 50,000/mm³, and severe if < 20,000/mm³ or < 50,000/mm³ with clinical bleeding. Results: A total of 143 episodes of blood culture proven sepsis in 131 neonates were studied. Gram positive bacteria identified in 33.6%, gram negative bacteria in 53.8%, and fungi in 12.6%. Klebsiella predominated among Gram negative bacteria (39%) and Candida species (94.4%) among fungi. Initial thrombocytopenia was observed in 84 (58.7%) episodes; it was mild, moderate, and severe in 39.3%, 25%, and 35.7% respectively. Initial thrombocytopenia among Gram positive, Gram negative, and fungal sepsis were 41.7%, 70.1%, and 55.6%, respectively. Severe thrombocytopenia in the respective groups was 20%, 44.4% and 20%. Overall (80%) and severe thrombocytopenia (45.8%) was highest in Klebsiella sepsis. Thrombocytopenia was moderate in 60% of Candida sepsis. An additional 23.7% had thrombocytopenia subsequently. In 51.2%, thrombocytopenia persisted beyond 3 days. Conclusions: Thrombocytopenia was observed in 58.7% of culture proven neonatal sepsis. Initial thrombocytopenia was common among Gram negative sepsis and mostly of a moderate degree in Candida sepsis.