Thrombocytopenia in early neonatal period — Is intravenous gamaglobulin useful?

To evaluate the role of Intravenous gamaglobulin (IVIG) and platelet transfusion on the improvement and survival of neonates with thrombocytopenia.

A 4 year prospective study involving all infants admitted to the Neonatal Intensive Care Unit between 1st June 1998 and 31st May 2002, was undertaken at the Kasturba Hospital, Manipal. Platelet counts were assessed for all infants within the 1st hrs of life, and subsequently at intervals of 12–24 hours. Thrombocytopenic infants with platelet counts progressively reducing to one-third the primary platelet count or those in who the platelet counts were less than 50,000 (which ever occurring earlier), were considered eligible for therapy and included for the study. Those unwilling for therapy due to personal or financial reasons were considered as ‘untreated-controls’. Infants admitted during the first phase of the study period (1st June 1998 to 31st May 2000) were treated with 10 ml/kg of platelet transfusion (Platelet group) and those admitted during the 2nd phase of the study (1st June 2000 to 31st May 2002) were given 800 mg/kg of IVIG. All other parameters of neonatal care were the same during the entire 4-year period of the study. The treated and untreated groups were compared and the role IVIG and platelet therapy in arresting the progressive reduction of platelets and reducing neonatal mortality were evaluated.

Among the thrombocytopenic infants, 77% (30/39) died if untreated, as compared to 38 % (21/55) of those given some form of specific therapy (Platelets or IVIG). (RR 0.5, 95 % CI 0.34–0.72, p = 0.0005). An increase in platelet counts and resultant survival was seen in 75 % (24/32) of thrombocytopenic infants treated with IVIG as compared to 43% (10/23) of those receiving platelet transfusion. (RR 0.44, 95% CI, 0.22–0.89, p = 0.036).

Specific therapy for increasing platelet counts would reduce the mortality in thrombocytopenic infants. IVIG could be considered a good first line drug in treating neonates with thrombocytopenia.