Diagnosis and treatment of transient neonatal thrombocytopenia (Draft clinical recommendations for discussion by specialists)

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Abstract

Transient neonatal thrombocytopenia occurs with a frequency of 0.7–0.9% and is divided by etiological factor into primary (alloimmune and transimmune) and secondary (symptomatic) thrombocytopenia, according to the time of occurrence of thrombocytopenia is divided into early and late. The main clinical manifestation of thrombocytopenia is hemorrhagic syndrome of varying severity, which occurs in 20–30% of newborns with thrombocytopenia, in other newborns thrombocytopenia is asymptomatic. The most severe clinical symptom is intracranial hemorrhages, which occur in 10–30% of cases. The most common types of bleeding of the platelet-vascular type are petechiae, ecchymoses, nosebleeds, melena, hematuria, cephalohematoma and other types of bleeding. In dynamics, symptoms of posthemorrhagic anemia may appear with massive bleeding (pallor, tachycardia, tachypnea, decreased blood pressure). The main criterion for the diagnosis of transient neonatal thrombocytopenia is a decrease in the number of platelets below the reference values for a given gestational and chronological age of a newborn child. To diagnose the type of thrombocytopenia, a thorough collection of maternal anamnesis is necessary, examination of parents if they suspect the immune nature of the disease, diagnosis of the disease as a result of which thrombocytopenia has developed, if it is secondary. Correction of thrombocytopenia, if indicated, is carried out by intravenous administration of platelet concentrate. If the immune nature of thrombocytopenia with severe thrombocytopenia is suspected and/or the presence of moderate and higher hemorrhagic syndrome, the administration of normal human immunoglobulin is recommended. If immunoglobulin therapy for immune thrombocytopenia is ineffective, glucocorticoids are prescribed.

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About the authors

Dmitry O. Ivanov

Saint Petersburg State Pediatric Medical University

Email: delopro@gpmu.org.ru
ORCID iD: 0000-0002-0060-4168
SPIN-code: 4437-9626

MD, PhD, Dr. Sci. (Medicine), Professor, Chief neonatologist of the Ministry of Health of the Russian Federation, Head of the Department of Neonatology with Сourses in Neurology and Obstetrics and Gynecology of Faculty of Retraining and Additional Professional Education, Rector

Russian Federation, Saint Petersburg

Galina N. Chumakova

Saint Petersburg State Pediatric Medical University

Author for correspondence.
Email: zelchum-neo@yandex.ru
ORCID iD: 0000-0001-5353-4610
SPIN-code: 1821-0198

MD, PhD, Dr. Sci. (Medicine), Professor of the Department of Neonatology with courses in Neurology and Obstetrics and Gynecology of Faculty of Retraining and Additional Professional Education

Russian Federation, Saint Petersburg

Ekaterina N. Balashova

Research Center for Obstetrics, Gynecology and Perinatology

Email: katbal99@gmail.com
ORCID iD: 0000-0002-3741-0770
SPIN-code: 1335-1489

MD, PhD, Assistant of the Department of Neonatology

Russian Federation, Moscow

Tamara V. Belousova

Novosibirsk State Medical University

Email: belousovatv03@yandex.ru
ORCID iD: 0000-0002-4234-9353
SPIN-code: 9651-0155

MD, PhD, Dr. Sci. (Medicine), Professor, Honored Doctor of Russia, Head of the Department of Pediatrics and Neonatology

Russian Federation, Novosibirsk

Elena V. Bem

Saint Petersburg State Pediatric Medical University

Email: e.bohm@inbox.ru
ORCID iD: 0009-0008-9337-5667
SPIN-code: 2811-5938

MD, PhD, Assistant of the Department of Neonatology with courses in Neurology and Obstetrics and Gynecology of Faculty of Retraining and Additional Professional Education

Russian Federation, Saint Petersburg

Anastasia Y. Kazantseva

Saint Petersburg State Pediatric Medical University

Email: enotz@inbox.ru
ORCID iD: 0000-0002-1234-9416
SPIN-code: 7175-8776

Hematologist, Oncohematology Department

Russian Federation, Saint Petersburg

Marina I. Levadneva

Saint Petersburg State Pediatric Medical University

Email: m-lev11@yandex.ru
ORCID iD: 0000-0001-6716-7567
SPIN-code: 2780-6674

Head of the Department of Newborn Physiology at the Perinatal Center, Assistant of the Department of Neonatology with Сourses in Neurology and Obstetrics and Gynecology of Faculty of Retraining and Additional Professional Education

Russian Federation, Saint Petersburg

Irina V. Myznikova

Saint Petersburg State Pediatric Medical University

Email: irinayurko2014@yandex.ru
ORCID iD: 0000-0002-8624-1854

Head of the Department of Pathology of Newborns and Young Children of the Perinatal Center, Assistant of the Department of Neonatology with courses in Neurology and Obstetrics and Gynecology of Faculty of Retraining and Additional Professional Education

Russian Federation, Saint Petersburg

Svetlana E. Pavlova

Saint Petersburg State Pediatric Medical University

Email: svetlanapav.spb@mail.ru
ORCID iD: 0000-0001-5423-0950
SPIN-code: 1761-4768

Assistant Professor of the Department of Neonatology with courses of Neurology and Obstetrics and Gynecology of Faculty of Retraining and Additional Professional Education

Russian Federation, Saint Petersburg

Aleksandra S. Panchenko

Saint Petersburg State Pediatric Medical University

Email: sashawomen18@mail.ru
ORCID iD: 0000-0003-2313-3941
SPIN-code: 9552-2350

MD, PhD, Dr. Sci. (Medicine), Professor of the Department of Neonatology with Courses of Neurology and Obstetrics and Gynecology of Faculty of Retraining and Additional Professional Education

Russian Federation, Saint Petersburg

Ksenia I. Pshenichnaya

Saint Petersburg State Pediatric Medical University

Email: kpshenichnay@yandex.ru
ORCID iD: 0009-0001-7172-7931
SPIN-code: 8603-5705

MD, PhD, Dr. Sci. (Medicine), Professor of the Professor I.M. Vorontsov Department of Children’ Diseases of Faculty of Retraining and Additional Professional Education

Russian Federation, Saint Petersburg

Larisa A. Romanova

Saint Petersburg State Pediatric Medical University

Email: l_romanova2011@mail.ru
ORCID iD: 0000-0003-0828-352X
SPIN-code: 6460-5491

MD, PhD, Associate Professor of the Department of Neonatology with courses in Neurology and Obstetrics and Gynecology of Faculty of Retraining and Additional Professional Education

Russian Federation, Saint Petersburg

Nina V. Subora

Saint Petersburg State Pediatric Medical University

Email: matchenkova@inbox.ru
ORCID iD: 0000-0001-9153-3803
SPIN-code: 6943-3382

Hematologist, Oncohematology Department

Russian Federation, Saint Petersburg

Larisa A. Fedorova

Saint Petersburg State Pediatric Medical University

Email: arslarissa@rambler.ru
ORCID iD: 0000-0001-9747-762X
SPIN-code: 5474-0902

MD, PhD, Associate Professor of the Department of Neonatology with courses in Neurology and Obstetrics and Gynecology of Faculty of Retraining and Additional Professional Education

Russian Federation, Saint Petersburg

Ekaterina E. Yakovleva

Saint Petersburg State Pediatric Medical University

Email: eeiakovleva@mail.ru
ORCID iD: 0000-0002-0270-0217
SPIN-code: 6728-7340

MD, PhD, Head of the Department of Clinical Pharmacology, Associate Professor of the Department of Pharmacology with the course of Clinical Pharmacology and Pharmacoeconomics

Russian Federation, Saint Petersburg

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2. Fig. 1. Platelet Count in newborns in the first 3 days of life at gestational age from 22 to 42 weeks [117]

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3. Fig. 2. MPV in term and late preterm infants during the first 90 days after birth [117]

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4. Fig. 3. Immature platelet fraction (IPF %) on the day of birth depending on the gestational age [65]

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