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A Clinical Study of Sepsis with Thrombocytopenia in Premature Infants

Korean Journal of Pediatrics 2004;47(10):1058-1064.
Published online October 15, 2004.
A Clinical Study of Sepsis with Thrombocytopenia in Premature Infants
Jae Hoon Sim, So Ick Jang, Yun Jung Sim, Do Jun Cho, Dug Ha Kim, Ki Sik Min, Ki Yang Yoo
Department of Pediatrics, College of Medicine, Hallym University, Chunchon, Korea
혈소판 감소증을 동반한 미숙아 패혈증의 임상 양상
심재훈, 장소익, 심은정, 조도준, 김덕하, 민기식, 유기양
한림대학교 의과대학 소아과학교실
Correspondence: 
Dug Ha Kim, Email: dougkim@hallym.or.kr
Abstract
Purpose
: This study was performed to characterize sepsis with thrombocytopenia in premature infants to determine if thrombocytopenia is a prognostic factor in sepsis in premature infants.
Methods
: We retrospectively analyzed the medical records of sepsis in premature infants admitted to the neonatal intensive care unit(N=41) at the Hallym University Sacred Heart Hospital from January 1999 to December 2002. The incidence, risk factors, symptoms, hematologic and bacteriologic findings were analyzed during episodes of sepsis.
Results
: Of the 41 cases, 29(72%) were associated with thrombocytopenia. The ratio of male to female was 1.2 : 1. The vast majority(98%) were late-onset sepsis. The risk factors of the thrombocytopenic group were low birth weight and low gestational age. Major symptoms were poor activity (72%), apnea/tachypnea(52%), but were not significantly different between two groups. In the thrombocytopenic group(N=29), low total WBC count and high CRP level were discovered(P=0.03, P<0.01). The mean platelet count was 70.17(?03/mm3) at diagnosis of sepsis, and a mean platelet nadir was 43.10(?03/mm3). The severe thrombocytopenia(below 50?03/mm3) in the thrombocytopenic group was discovered in 69% and the duration of thrombocytopenia was about eight days. The majority of pathogens were gram-negative bacteria and candida. The thrombocytopenic group showed a prolonged length of stay and a high mortality rate. According to comparisons between the survived and expired groups, low birth weight, low gestational age, neutropenia and thrombocytopenia were significantly correlated with mortality(P<0.05).
Conclusion
: The sepsis with thrombocytopenia in premature infants showed late-onset sepsis and high morbidity and mortality, although differences were not significant statistically. Especially, low birth weight and low gestational aged infants should be cautiously treated and monitored.
Key Words: Premature infant, Sepsis, Thrombocytopenia


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