Prevalence of Thrombocytopenia and Its Associated Factors Among Neonates Admitted in Neonatal Intensive Care Unit of Addis Ababa Public Hospitals, Ethiopia 2020/21(Cross Sectional Study)

doi:10.21203/rs.3.rs-1431306/v1

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Prevalence of Thrombocytopenia and Its Associated Factors Among Neonates Admitted in Neonatal Intensive Care Unit of Addis Ababa Public Hospitals, Ethiopia 2020/21(Cross Sectional Study)

https://doi.org/10.21203/rs.3.rs-1431306/v1

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Background: Thrombocytopenia is one of the most frequent hematologic disorders encountered in the sick neonate. This is evidenced by a fairly high prevalence among neonates admitted to the neonatal intensive care unit 22%-35%, especially in very-low-birth-weight and preterm neonates its prevalence is up to 70%-80%. In Africa, the prevalence of neonatal thrombocytopenia in Nigeria is 53%, 12.4% in Tunisia, and 16.2% in Libya. However, in Ethiopia, there is limited study assessed both its prevalence and associated factors.

Objective: to assess the prevalence of thrombocytopenia and its associated factors among neonates admitted to neonatal intensive care unit at public hospitals in Addis Ababa in 2020/21.

Method: Institution based cross sectional study was conducted at NICU of selected Addis Ababa public hospitals from February 15^thto March 15^th, 2021. Single population proportion formula was used to determine sample size. The final sample size was 423. The collected data entered using Epi data and exported to SPSS version 25 for analysis. Variables that have P-value<0.05in bivariable entered in to multivariable logistic regression model to control for confounder. Statistical significance declared at p-value <0.05.

Results: The prevalence of neonatal thrombocytopenia in the study area is 66%.In this study variables such as eclampsia(AOR=4.8, 95%CI: 2.66-13.94), Prolonged rupture of membrane(AOR=0.26, 95%CI:0.101-0.669), Intra uterine growth retardation(AOR=0.26, 95%CI: 0.1-0.68), neonatal sepsis (AOR=11.98, 95%CI: 4.023-25.7), Perinatal asphyxia(AOR=6.68, 95%CI: 2.616-17.6), Necrotizing enterocolitis (AOR=14.6, 95%CI: 2.84-35.61) and prolonged nothing per mouth(AOR=0.243,95%CI: 0.084-0.705) were factors associated with neonatal thrombocytopenia.

Conclusion and recommendation: Prevalence of neonatal thrombocytopenia in Addis Ababa public hospitals neonatal intensive care unit is high. Therefore, identifying factors associated with it used as an input in reducing the problem.

neonate

thrombocytopenia

platelet

neonatal intensive care unit

Thrombocytopenia is defined as platelet count less than 150,000 platelet per micro liter of blood regardless of the gestational age(1), and multiple disease processes can cause neonatal thrombocytopenia and is classified based on platelet count as mild thrombocytopenia platelet count between 100 to 149 × \({10}^{3}\) /µL, moderate thrombocytopenia platelet count between 50 to 99 × \({10}^{3}\)/µL, and severe thrombocytopenia platelet count less than 50 x\({ 10}^{3}\)/ µL(2, 3). It is also categorized based on onset of duration to early onset thrombocytopenia which occurs before 72 hours after birth and late onset thrombocytopenia which occurs after 72 hours of birth(4).

Among hematological disorder in neonate thrombocytopenia is the most common disorder which occurs in the neonatal intensive care unit(5, 6). This group of disorders results when platelets are either decreased in number due to placental insufficiency, increased destruction (consumption) of platelets, or a combination of both mechanisms(7).

Neonatal thrombocytopenia had a major impact on haemostatic integrity. It can cause gastrointestinal, pulmonary bleeding, and intracranial hemorrhage. Preterm neonates have one of the highest rates of intracranial hemorrhage (ICH), which affects up to a quarter of those with low birth weight(8). The most serious complication of severe fetal and neonatal thrombocytopenia is intracranial hemorrhage (ICH), which is detected in 10–20% of affected fetuses/neonates, with most cases occurring after a week of life. Intracranial hemorrhage leads to neurological squeal in 20%, and deaths in 5–10% cases(9).

Thrombocytopenia rate in preterm neonates with birth weight less than 1000g and 750g is reported to occur in up to 75% and 90% of neonates, respectively(10). Expert review on hematology report showed that low-birth weight infants were at a 2.5fold increased risk for thrombocytopenia(8).

Most studies report higher rates of neonatal thrombocytopenia ranging between 53–70% in developing countries when compared to developed countries it ranges 18–35%, (11). Neonatal morbidity and mortality are concerning health problems among low and middle-income countries, among sick neonates thrombocytopenia is prevalent from hematologic disorders(12). In developing country neonatal death secondary to bleeding is high due to sepsis is prevalent in neonatal intensive care unit and also Preterm birth is high in low income countries which is the leading cause of morbidity and mortality in neonates worldwide (11).

Even if thrombocytopenia has a high prevalence, complications, and economic burden, the emphasis given to the problem is insignificant in our setup as well as in our country. While prevention and early management of this condition by identifying factors associated with thrombocytopenia may enhance the prognosis of neonates. Therefore, this study shows the prevalence of neonatal thrombocytopenia and its associated factors in neonates admitted to neonatal intensive care units in Addis Ababa public hospitals.

Study Design, study period and Study area

An institution-based cross sectional study was conducted among neonates admitted at Addis Ababa selected public hospitals. The study was carried out at four randomly selected public hospitals of Addis Ababa, Ethiopia, from February 15 to 15 March 2021 using records of admitted neonates in NICUs from January 1st to December 30th, 2020.The study was conducted in Addis Ababa, which is the capital city of Ethiopia and the seat of the African Union and the United Nations World Economic Commission for Africa. It covers an area of 527 square kilometers and has 11 sub-cities. According to population projection value for 2019, the city has an estimated population of 4.592 million(13). The city has 12 public Hospitals; from those 11 hospitals have neonatal intensive care unit. The study was conducted in Ghandi Memorial Hospital, Saint Paul Millennium Medical College Hospital, Yekatit 12 Hospital and Tikur Anbessa Specialized Hospital.

Population

The source populations were all neonates who were admitted in Addis Ababa public hospital neonatal intensive care unit from January 2020- December 2020 G.C and the study population is all randomly selected neonates’ who were admitted in neonatal intensive care unit of selected Addis Ababa public hospitals from January 2020- December 2020 G.C.

Inclusion and exclusion criteria

All eligible medical charts (records) of neonates admitted to neonatal intensive care units from January 1st 2020 to December 30th 2020 were included in the study. Neonates who had incomplete medical record and Newborn who is diagnosed with Down syndrome, Edward syndrome and Patau syndrome were excluded.

Sample size and sampling procedure

The sample size was determined by using single population proportion formula by taking the prevalence of thrombocytopenia 48.9% previously done in Ethiopia and by adding 10% non response rate final sample size becomes 423. Allocation of the sample size to each hospital is made based on their average number of neonate admission per year which is from the annual neonatal admission report of each hospital. The overall sample was taken proportionally from all selected public hospitals. The first participants (medical chart of the neonate) were selected randomly during the beginning of the data collection time, and then each neonatal medical record selected using a systematic sampling technique in which every \({k}^{th}\)(k = 24) interval included until the required sample size obtained.

Operational definitions

Prolonged NPO-a neonate who is NPO for greater than 24 hours(14). Thrombocytopenia- a platelet count of less than 150,000 platelets per micro liter of blood regardless of the gestational age(2, 3). Mild thrombocytopenia- platelet count between 100 to 149 × \({10}^{3}\) / micro litter(2, 3). Moderate thrombocytopenia- platelet count between 50 to 99 × \({10}^{3}\) / µ L(2, 3). Severe thrombocytopenia- platelet count less than 50 x\({ 10}^{3}\) / µ L(2, 3). Prolonged rupture of membrane- Rupture of membrane more than 18 hours(15).

Variables

Outcome variable is neonatal thrombocytopenia dichotomized as (thrombocytopenic = 1,not thrombocytopenic = 0). Independent variables includes, Socio-demographic and maternal Obstetrics factors - maternal age, place of residency, gestational hypertension, antepartum hemorrhage, ANC follow up, parity, prolonged rupture of membrane, mode of delivery and gestational diabetes millets, Neonatal related factors - Sex, gestational age, birth weight and age at admission, Neonatal clinical co-morbidities includes neonatal sepsis, perinatal asphyxia, necrotizing enterocolities, neonatal surgical disorders.

Method of data collection and Data collection tool

Data extraction cheeklist was adapted by reviewing related literatures (16–20)and modified according to our context. The medical charts of neonates admitted to selected Addis Ababa public hospitals over one year (January 2020-december 2020 GC), was collected by using sampling frame from registration book. Then using the checklist, socio-demographic characteristics of the mother, pre-existing maternal chronic disease maternal obstetric history during pregnancy, maternal obstetric complications for the index pregnancy, neonatal related factors and clinical co-morbidities of the neonate was included in the data extraction checklist. During the process, the principal investigator was supervising the data collectors.

Data Analysis Procedure

The collected data was cleaned and sorted using Epi-Data software version 4.6. Entered data was exported and analyzed using SPSS Software version 25. Descriptive statistics like frequency, measure of central tendency and standard deviation was computed to describe the study variable in relation to the population. Hosmer and Lemeshow goodness of fit test and omnibus tests of model coefficients were done to test the fitness of the logistic regression in the final model, then it was found good (statistically insignificant value, P value > 0.05). Bivariate and multivariable logistic regression carried out to see associations between dependent and independent variables. Those variables that have p value < 0.05 in bivariable logistic regression were taken to the multivariable logistic regression model to adjust for possible confounders. The strength of the association declared at p-values < 0.05 with 95% CI.

Socio-demographic characteristics of mother and their baby

In this study, the medical records of 423 neonates were reviewed. The mean maternal age for the index pregnancy was 28.11(± 4.903) and 155(36.6%) of mothers were in the age group of 25–29 year. Ninety-one percent of mothers were urban residents the rest nine percent is from rural. Out of 423 neonates 229(54.1%) were male and 194(45.9%) were female. More than half of neonates 260(61.5%) were admitted before 24 hours of postnatal age (Table 1).

Table 1

Socio-demographic characteristics of mothers and neonates at NICU of selected public hospitals of Addis Ababa, Ethiopia, 2021 (n = 423).
Variables	Frequency	Percentage (%)
Age_ group of the mother (Year) ≤ 24 25–29 30–34 ≥ 35	111 155 115 42	26.2 36.6 27.2 9.9
Residency Urban Rural	385 38	91 9
Age at admission of the newborn < 24hours ≥ 24hours	260 163	61.5 38.5
Sex of the newborn Male Female	229 194	54.1 45.9

Obstetrical history of mother’s

Majority of the mothers, 410 (96.9%) had ANC follow up for the index pregnancy. Among those mothers who had ANC follow up, 353(86.1%) of them having four and above visit. Majority of mothers 403 (95.3%) delivered their babies at health institution (Table 2).

Table 2

Obstetric history of mothers whose neonates were admitted in NICU of selected Addis Ababa public hospitals, Ethiopia, 2021 (n = 423).
Variables	Frequency	Percentage (%)
ANC visit Yes No	410 13	96.9 3.1
Number of ANC visit(n = 407) 1–3 ≥ 4	57 353	13.9 86.1
Place of delivery Health institution Home	403 20	95.3 4.7
Parity Primi para Multi-para	119 304	28.1 71.9
Mode of delivery SVD Assisted vaginal delivery C/S	211 69 143	49.9 16.3 33.8
Type of pregnancy Single Multiple	378 45	89.4 10.6
VDRL Test Reactive Non-reactive Unknown	30 384 9	7.1 90.8 2.1

Obstetric Complications of the Mother

Regarding to maternal obstetric complications more than half 273(64.5%) mothers had obstetric complication during the index pregnancy. Among maternal obstetric complications for the current pregnancy proportion of PROM, eclampsia and APH is 123 (45.1%), 118(43.2%), and 64(23.4%) respectively (Fig. 1).

Neonatal related factors

Among 423 reviewed neonatal records more than half of the neonates 243(57.4%) birth weight was greater than 2500 gram. The mean birth weight is 2491(± 728) gram. Regarding gestational age almost half of the baby 223(52.7%) was born after 37 completed weeks of gestation (Table 3).

Table 3

Characteristics of neonates who were admitted in NICU of selected Addis Ababa public hospitals, Ethiopia, 2021 (n = 423).
Variables	Frequency	Percentage (%)
Birth weight < 2500 g ≥ 2500 g	180 243	42.6 57.4
Gestational Age < 37 wks ≥ 37 wks	200 223	47.3 52.7
Weight for gestational age Appropriate for gestational age(AGA) Small for gestational age (SGA) Large(LGA)	355 66 2	83.9 15.6 0.5
Did the newborn NPO Yes No	187 236	44.2 55.8
How long NPO < 24 hours ≥ 24 hours	5 182	2.7 97.3
APGAR score 5th min 0–3 4–6 7–10	1 50 372	0.2 11.8 87.9

Neonatal clinical co-morbidities

Out of 423 reviewed charts neonates admitted in NICU regarding co-morbidities more than half of neonates 285(66%) had neonatal sepsis, 95 (22.5%) had necrotizing enterocolities and 95(22.5%) had perinatal asphyxia (Table 4).

Table 4

clinical co-morbidities of the neonates in selected Addis Ababa public hospitals 2021G.c (n = 423).
Variables	Frequency	Percentage (%)
Sepsis(n = 423) Yes No	279 144	66 34
PNA Yes No	95 328	22.5 77.5
NHB Yes No	77 346	18.2 81.8
NEC Yes No	95 328	22.5 77.5
Surgical Disorders Yes No	70 353	16.5 83.5

Prevalence of neonatal thrombocytopenia

Out of 423 neonates who were admitted in NICU of Addis Ababa public hospitals 279(66%) neonates were developed thrombocytopenia. From thrombocytopenic neonates 73(26.2%) had mild thrombocytopenia, 107(38.3%) had moderate thrombocytopenia and 99(35.5%) neonates had sever thrombocytopenia. Based on onset of thrombocytopenia 78(28%) had early onset thrombocytopenia and 201(72%) had late onset thrombocytopenia.

Factors associated with neonatal thrombocytopenia

To identify factors associated with neonatal thrombocytopenia logistic regression model was used. Variables that were used in bi-variable regression with the crude odds ratios (COR) and P value < 0.05associated with neonatal thrombocytopenia includes age at admission of the baby, PROM, eclampsia, IUGR, neonatal sepsis, PNA, neonatal hyperbilirubinemia, NEC, neonatal surgical disorders, birth weight, gestational age, and prolonged NPO.

Then multivariable logistic regression analysis was used to adjust possible confounders. In multivariable logistic regression analysis factors that were significantly associated which showed p-value of below 0.05 with the outcome variable (neonatal thrombocytopenia) were PROM, eclampsia, IUGR, Sepsis, PNA, NEC and prolonged NPO.

Eclampsia had statistically significant association with neonatal thrombocytopenia. The odds of babies born from mother who had obstetric complication of eclampsia were 4.8 times more likely develop thrombocytopenia than those delivered from mother who had no eclampsia during pregnancy[AOR: 4.82, 95%CI:(2.668–13.949)].

Sepsis had significantly associated with neonatal thrombocytopenia. Those neonates who hadclinical co-morbidity of sepsis were 12 times more likely develop thrombocytopenia than those who had no co-morbidity of sepsis [AOR: 11.987; 95%CI (4.023–25.72)].

The odds of neonates who had clinical co-morbidity of perinatal asphyxia were 6.68[AOR = 6.68, 95% CI :( 2.616–17.653)] times more likely develop thrombocytopenia when compared to those neonates who had no clinical co-morbidities of perinatal asphyxia.

The odds of neonates who had co-morbidity of necrotizing enterocolities were 14.65[AOR = 14.653, 95% CI: 14.653(2.84-35.618)] times more likely develop thrombocytopenia compared to those neonates who had no co-morbidity of NEC (Table 5).

Table 5

Factors associated with neonatal thrombocytopenia among neonates admitted in NICU of selected Addis Ababa public hospitals, Addis Ababa, Ethiopia, 2021. (n = 423).
Variables	Thrombocytopenia		COR(95% CI)	AOR(95% CI)
Variables	Yes	No	COR(95% CI)	AOR(95% CI)
Age at admission < 24 hours ≥ 24 hours	182(65.2%) 97(34.8%)	78(54.2%) 66(45.8%)	1 0.63(0.418–0.949)*	1 1.944 (0.746–5.068)
ANC follow up 1–3 times ≥ 4 times	46(65.7%) 233(66%)	24(34.3%) 120(34%)	1 1.013(0.59–1.73)
VDRL test Positive Negative Unknown	23(76.7%) 248(64.6%) 8(88.9%)	7(23.3%) 136(35.4%) 1(11.1%)	0.411(0.044–3.87) 0.22(0.028–1.84) 1
Parity Primi Multi	78(65.5%) 201(66.1%)	41(43.5%) 103(33.9%)	1 1.026(0.656–1.603)
Birth weight < 2500 g ≥ 2500 g	141(78.3%) 138(56.8%)	39(21.7%) 105(43.2%)	1 0.364(0.235–0.562)*	1 0.567(0.161–1.991)
Source of admission Inborn Out born	233(66%) 46(65.7%)	120(34%) 24(34.3%)	1 0.987(0.57–1.69)
Eclampsia Yes No	109(47.2%) 122(52.8%)	9(21.4%) 33(78.6%)	1 3.276(1.50-7.154)*	1 4.82(2.668–13.949)**
SPE Yes No	83(84.7%) 148(84.6%)	15(15.3%) 27(15.4%)	1 1.009(0.508–2.005)
Gestational Age < 37 wks ≥ 37 wks	163(81.5%) 116(52%)	37(18.5) 107(48%)	1 4.064(2.609–6.33)*	1 0.446(0.129–1.542)
PROM Yes No	96(41.6%) 135(58.4%)	27(64.3%) 15(35.3%)	1 0.395(0.199–0.782)*	1 0.26(0.101–0.669)**
APH Yes No	57(89.1%) 174(83.3%)	7(10.9%) 35(16.7%)	1 1.638(0.69–3.89)
IUGR Yes No	100(43.3%) 131(56.7%)	23(54.8%) 19(45.2%)	1 0.631(0.25–0.951)*	1 0.260(0.100–0.680)**
GDM Yes No	43(89.6%) 188(83.6%)	5(10.4%) 37(16.4%)	1 1.693(0.628–4.55)
Place of delivery Health Institution Home	266(66%) 13(63%)	137(34%) 7(35%)	0.956(0.373–2.453) 1
Sepsis Yes No	218(78.1%) 61(21.9%)	61(42.4%) 83(57.6%)	1 4.863(3.145–7.518)*	1 11.98(4.023–25.72)**
PNA Yes No	84(30.1%) 195(69.9%)	11(7.6%) 133(92.4%)	1 5.206(2.67-10.138)*	1 6.68(2.616–17.653)**
NHB Yes No	43(15.4%) 236(84.6%)	34(23.6%) 110(76.4%)	1 0.589(0.356–0.975)*	1 1.978(0.624–6.266)
NEC Yes No	89(31.9%) 190(68.1%)	6(4.2%) 138(95.8%)	1 10.7(4.581–25.3)*	1 14.65(2.84-35.618)**
Neonatal surgical disorders Yes No	62(22.2%) 217(77.8%)	8(5.6%) 136(94.4%)	1 4.85(2.256–10.458)*	1 2.214(0.548–8.943)
NPO Yes No	175(62.7%) 104(37.3%)	49(34%) 95(66%)	1 0.307(0.201–0.467)*	1 0.243(0.084–0.705)**
Key1 = Reference, = significant (p-value < 0.05), *=significant (p-value < 0.05)

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.

The overall prevalence of neonatal thrombocytopenia among neonates admitted in neonatal intensive care unit of Addis Ababa public hospitals during the period of from January 1st 2020 to December 30th 2020 is 66% which is higher from other studies conducted before. From thrombocytopenic neonates 99(35.5%) had sever thrombocytopenia, 107(38.4%) had moderate thrombocytopenia and 72(26.2%) had mild thrombocytopenia. Out of 279 neonates who developed thrombocytopenia 78(28%) had early onset thrombocytopenia and 201(78%) had late onset thrombocytopenia.

Moreover, the study found that PROM, eclampsia, IUGR, Sepsis, PNA, NEC and prolonged NPO were significantly associated with neonatal thrombocytopenia.

ANC: Antenatal Care; AOR: Adjusted Odds Ratio; APGAR: Appearance, Pulse Rate, Grimace, Activity, Respiration Rate; APH: Antepartum Hemorrhage; GDM: Gestational Diabetes Miletus; NEC: Necrotizing Enterocoltis; NICU: Neonatal Intensive Care Unit; PNA: Perinatal asphyxia; NPO: Nothing per Oath; PROM: prolonged rupture of membrane.

Ethical Consideration

To conduct this study, the authors tried to address the Declaration of Helsinki’sethical principles for medical research. In this study, it was impossible to get informed consent from the neonates’ families because the authors had no contact either with the neonates or families, and the data were collected from neonates' medical charts after they were discharged. But the study was conducted after the approval of a research ethics committee. Ethical clearance with the reference number IRB03-008/2021 and IRB 7886/227 was obtained from the Institutional Review Board of Addis Ababa University and Addis Ababa city health bureau. Then, a formal letter of cooperation was submitted to the study units (Neonatal department and card room) and permission was secured before data collections were initiated. Information obtained from the patient records was kept anonymous and confidentiality was maintained.

Consent for publication

All authors agreed that this manuscript is eligible for publication.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector

Author’s contribution

MW: conceptualization, methodology, software, formal analysis, writing original draft, NT and HL: validation, data curation, reviewing and editing. AD, DB, FB and HT: conceptualization, methodology, data cleaning, writing, reviewing and editing. Finally, all authors approved the manuscript.

Competing interests

The authors declare that no competing interests in this study.

Data Availability statement

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request ([email protected], cell phone +251922899058).

Acknowledgement

We would like to extend thanks to Addis Ababa University, Dr. Asrat, VON members, all staff members of the card room that working in Tikur Anbesa, St. paul, Gandi, and Yekatit 12 hospitals and all the data collectors for their valuable contribution to the realization of this study.

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No competing interests reported.

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Prevalence of Thrombocytopenia and Its Associated Factors Among Neonates Admitted in Neonatal Intensive Care Unit of Addis Ababa Public Hospitals, Ethiopia 2020/21(Cross Sectional Study)

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Abstract

Figures

Introduction

Method

Results

Socio-demographic characteristics of mother and their baby

Obstetrical history of mother’s

Obstetric Complications of the Mother

Neonatal related factors

Neonatal clinical co-morbidities

Prevalence of neonatal thrombocytopenia

Factors associated with neonatal thrombocytopenia

Discussion

Conclusion

Abbreviations

Declarations

References

Additional Declarations

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