Petechial Hemorrhage: A clinical diagnosis of neonatal Thrombocytopenia and sepsis

Document Type: Case Report

Authors

1 Fernandez Hospital ,ooposite OLD MLA quarters

2 Fernandez Hospital,

3 Fernandez Hospital Hyderabad

Abstract

A preterm female baby with birth weight of 1.5kg was referred to our hospital on day 6 for difficulty in breathing. Baby was admitted at birth for respiratory distress and feed intolerance to other hospital and in view of clinical deterioration baby was referred. Baby had thrombocytopenia with platelets counts of 11000/ mm3 and high CRP titer. Baby had petechial haemorrhagic spots all over the body with hepatosplenomegaly and sclerema (figure 1,2,3). Baby further platelets counts were 3000, 43000, 67000 and then normal. Baby was managed with antibiotics and platelets transfusion. Gradually baby counts improved and petechial spots disappeared.
Discussion
Neonatal Sepsis is a common complication in the neonatal intensive care unit. It is most common in the smallest and most premature infants in whom the clinical presentation can be subtle and nonspecific. Thrombocytopenia is the common manifestation of neonatal sepsis in sick babies(1). The manifestation can be seen in newborn as petechial spots over the body with predominance over chest and abdomen(2).Thrombocytopenia is seen in 18% to 35% of NICU patients, and in 73% of extremely low birth weight (ELBW) infants(3). Bacterial,fungal and viral infection causes thrombocytopenia. Infection causes damage to vascular endothelium which increases the destruction of platelets and there removal by reticuloendothelial system(4)

Keywords


Case

A preterm female baby with birth weight of 1.5kg was referred to our hospital on day 6 for difficulty in breathing. Baby was admitted at birth for respiratory distress and feed intolerance to other hospital and in view of clinical deterioration baby was referred. Baby had thrombocytopenia with platelets counts of 11000/ mm3 and high CRP

titer. Baby had petechial haemorrhagic spots all over the body with hepatosplenomegaly and sclerema (Figure 1). Baby further platelets counts were 3000, 43000, 67000 and then normal. Baby was managed with antibiotics and platelets transfusion. Gradually baby counts improved and petechial spots disappeared.

 

 

Figure 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Discussion

Neonatal Sepsis is a common complication in the neonatal intensive care unit. It is most common in the smallest and most premature infants in whom the clinical presentation can be subtle and nonspecific. Thrombocytopenia is the common manifestation of neonatal sepsis in sick babies (1). The manifestation can be seen in newborn as petechial spots over the body with predominance over chest and abdomen (2). Thrombocytopenia is seen  in 18% to 35% of NICU patients, and in 73% of extremely low birth weight (ELBW) infants (3). Bacterial,fungal and viral infection causes thrombocytopenia. Infection causes damage to vascular endothelium which increases the destruction of platelets and there removal by reticuloendothelial system (4).

 

Lesson to clinicians

  1. In neonates thrombocytopenia is very common in sepsis which can present as petechial spots. Treating physicians must notice these clinical presentation of sepsis and treat them.
  2. When baby have sclerema and thrombocytopenia, clinical suspicion of sepsis must be given importance and baby started on antibiotics without waiting for laboratory results.
  1. Lee KH, Hui KP, Tan WC. Thrombocytopenia in sepsis: a predictor of mortality in the intensive care unit. Singapore Med J. 1993; 34:245-6.
  2. Sinha ND, Mukherjee AK. Septicemia in neonates and early infancy. Indian J Pediatr. 1986; 53:243-56.
  3. Reidler GF, Straub PW, Frick PG. Thrombocytopenia in septicemia. A clinical study for the evaluation of its incidence and diagnostic value. Helv Med Acta. 1971; 36:23-38.
  4. Thorne KJ, Oliver RC, MacIntyre DE, Gordon JL. Endotoxin-induced platelet aggregation and secretion changes in plasma membrane proteins. J Cell Sci. 1977; 28:225-36.