Thrombocytopenia is a common clinical problem globally among newborns that are sick and admitted in neonatal intensive care unit which is comparable with other hematologic disorder of newborns like Anemia, hemorrhagic disease of newborns and disseminated intravascular coagulopathy. Despite the significant burden in newborns health across all global regions, thrombocytopenia has been largely ignored until recently; especially in our country NICU setup. So this study assessed the prevalence which is 66% and factors associated with neonatal thrombocytopenia (which is eclampsia, PROM, IUGR, Sepsis, PNA, NEC and prolonged NPO) among neonates admitted in NICU of Addis Ababa public hospitals.
This study revealed that the prevalence of neonatal thrombocytopenia is 66%.This finding is higher than in studies done in India 45%(16), Iran 17.9% (21),Nepal 18%(22)Nigeria 53%(19),Libya 16.2%(20), and in study done in Ethiopia previously 48.9%(23). This may be due to neonatal sepsis and perinatal asphyxia is higher in our country neonatal intensive care unit which is the leading cause of neonatal morbidity and mortality in Ethiopia(24)and also due to poor infection prevention in hospitals. In Ethiopia hospitals the infection prevention practice was 52.2%(25) while in settings in which earlier studies have been conducted was 76.2% in India(26) and 70% in Iran(27).And also this finding is higher than the average global prevalence of neonatal thrombocytopenia which is 22–35%(28).This may be due to most of the studies are conducted in developed countries so it lowers the prevalence globally.
In this study 78(28%) had early onset thrombocytopenia and 201(72%) had late onset thrombocytopenia. This is similar with a study done in Nigeria, In their results16% were early onset and 84% late onset(19). It shows higher late onset thrombocytopenia, this may be due to among risk factors of thrombocytopenia neonatal factors are higher (sepsis, PNA, NEC, and prolonged NPO). Since most of the time late onset thrombocytopenia occurs as a result of neonatal factors. In contrast a study done in Austria their result shows among thrombocytopenic neonates 84.1% had early onset thrombocytopenia and 15.9% had late onset thrombocytopenia(29).the possible reason for this difference may be due to low association of maternal risk factors in our study which is responsible for the occurrence of early onset thrombocytopenia.
This study showed that among thrombocytopenic neonates 26.2% had mild thrombocytopenia, 38.3% had moderate thrombocytopenia and 35.5% neonates had sever thrombocytopenia. This is almost similar with study done in Libya(20),India(18)and Iran(21).the possible justification for this may be due to similarity in risk factors such as sepsis which results the occurrence of higher rate of sever thrombocytopenia and similarity in neonatal intensive care unit setting.
In this study, eclampsia was significantly associated with thrombocytopenia. The odds of babies born from mother who had maternal complication of eclampsia were 4.8 times more likely develop thrombocytopenia than those delivered from mother who had no eclampsia during pregnancy [AOR: 4.824,95%:CI (2.668–13.949)]. This finding is in line with the study conducted in India (16), Indonesia (30) and Austria(29). This may be due to lack of resource and adequate knowledge to manage and follow pregnancy induced hypertension in developing countries. Since eclampsia cause placental insufficiency by which it results decreased platelet production.
Among neonates delivered from mothers who had no prolonged rupture of membrane as obstetric complication were 74% less likely develop thrombocytopenia compared with those born from mother who had PROM. This finding is higher in a study conducted in India 7.5%(18). This may be due to low awareness on birth preparedness and lack of knowledge among pregnant mothers on early rupture of membrane and its complication(31).
In this study neonates with co-morbidity of neonatal sepsis were 12 times more likely to develop thrombocytopenia than those who had no co-morbidity of sepsis. This finding is higher than studies done in Austria 47.1%(29), Indian48.5% (18), Iran 50%(32) and Indonesia 43% (30). This may be due to sepsis is prevalent in NICU of the study area and low infection prevention in neonatal intensive care unit and also may be due to low pregnant women infection screening. Sepsis increases the risk of thrombocytopenia by destruction and consumption of platelet.
In this study, Perinatal asphyxia had significant association with neonatal thrombocytopenia. The odds of developing thrombocytopenia among neonates who had perinatal asphyxia as clinical co-morbidities is 6.68 times more likely develop thrombocytopenia when compared to those neonates who had no co-morbidity of perinatal asphyxia. This finding was agreed with studies conducted in Nepal 35.1%(22), Nigeria 33.3%(19),Indonesia 32.1%(30)and Pakistan 28.8%(17).this may be due to inadequate labor and delivery follow up by health professionals and lack of resource to follow intrauterine fetal condition during labor in developing countries. And also most of delivery time is night time in our country during this time there is lower number of staff in duty when compared to day time and they become tired so it results poor labor and delivery follow up.
The odds of neonates who had co-morbidity of necrotizing enterocolities were 14.65times more likely develop thrombocytopenia compared to those neonates who had no NEC. This finding is higher than studies conducted in Austria 4.1%(29), Iran10%(16) and Tunisia 1.9%(33). The possible reasons for this difference which may be due to preterm delivery is higher in our country since prematurity is the single greatest risk factor for necrotizing enterocolitis. But this finding is lower than when compared to a study conducted in India which is all newborns with NEC develop thrombocytopenia (16) and Indonesia 36%(30).This may be due to preterm delivery is lower in Ethiopia than in India.
The result of this study shown that neonate who is not IUGR was 74% less likely develop thrombocytopenia than those born being IUGR. This finding is lower than in study conducted in India80% (16), in Sri Lanka 70.7%(34).This may be due to low maternal chronic illness in our country like diabetes Miletus, cardiac disease and renal disease. And it is similar with a study done in Tunisia 26% (33).this may be due to similarity with socio-demographic characteristics of the two countries and also similarity with setup of the healthcare system.
Finally, newborns who were NPO for more than 24 hour had association with neonatal thrombocytopenia .The odds of newborns who were not NPO for longer than 24 hours 76%[AOR = 0.243, 95% CI:(0.084–0.705)]less likely develop thrombocytopenia. This is supported by the science of American Academy of Pediatrics (APA)(35, 36).
In this study by multivariable logistic regression variables not associated with the adjusted odds ratios (AOR) for neonatal thrombocytopenia includes neonatal surgical disorders, gestational age, birth weight, age at admission and neonatal hyperbilirubinemia.