The clinical significance of thrombocytopenia in neonates with necrotizingenterocolitis

Purpose: The aim of this study was to evaluate the clinical significance of low platelet count in the surgical management of neonates with necrotizing enterocolitis (NEC). Methods: The clinical course of 58 consecutive neonates with advanced NEC ( Bell's stages II or III) treated in the authors' hospital between 1995 and 1998 was reviewed. NEC in neonates who required operation was classified as isolated, multifocal, or pan-intestinal. Severe thrombocytopenia was defin ed as platelet count less than 100 X 10(9)/L. Rapid fall in platelet count was defined as fall greater than 150 X 10(9)/L within 24 hours to a level l ess than 100 x 109/L. Results: Median birth weight was 1,564 g (range, 550 to 4,270) and gestatio nal age was 31 weeks (range 23 to 41). Twenty-two neonates (38%) were below 1,000 g. Age at the onset of the disease was 13 days (range, 1 to 62). NEC was treated medically in 7 neonates (12%). Indications for operation inclu ded pneumoperitoneum in 23 neonates (45%), clinical deterioration in 19 (37 %), and intestinal obstruction in 9 (18%). The nadir platelet count (lowest level during the course of disease) was lower in patients with stage III d isease than in patients with stage II disease (P < .05). The greater the ex tent of the disease, the lower the platelet count (P = .012). The nadir pla telet count was lower in infants who died than in survivors (P < .05). None of the patients with platelet count greater than 100 x 109/L died. In pred icting intestinal gangrene, severe thrombocytopenia has a sensitivity of 69 %, specificity of 60%, and positive predictive value of 89%; rapid fall in platelet count has a sensitivity of 32%, specificity of 89%, and positive p redictive value of 92%. Conclusions: (1) A platelet count less than 100 x 109/L or a rapid fall in platelet count represent poor prognostic factors. (2) Monitoring the platel et count during the course of NEC is useful; however, it cannot be used in isolation to predict the extent of the disease or survival rate. J Pediatr Surg 36:799-803. Copyright (C) 2001 by W.B. Saunders Company.