











































12. Frequency and outcome of thrombocytopenia.ai


| Original  |  Article | 

Frequency and outcome of thrombocytopenia in neonates who are at risk 

of developing thrombocytopenia - a prospective observational study

Sarbari Saha, Debabrata Roy, Ismat Jahan, Mohammad Kamrul Hassan Shabuj, Sadeka 

Choudhury, MA Mannan, Mohammod Shahidullah,  Sanjoy Kumer Dey

Introduction:

Thrombocytopenia is the commonest 

hematological abnormality encountered 

in the neonatal intensive care unit 

(NICU) after phlebotomy-induced 

anemia.1 Perinatal asphyxia, 

prematurity/low birth weight, and 

sepsis are major causes of neonatal death. 

Thrombocytopenia is a common finding 

in these sick neonates. If not detected 

early & intervention not taken, 

life-threatening hemorrhage can occur.  

A healthy neonate, even preterm, has the 

same mean platelet count as adults, and a 

platelet count less than 150,000/cmm            

is defined as thrombocytopenia.2 

Thrombocytopenia develops in 22–35% 

of sick newborn babies admitted to 

neonatal intensive care units (NICUs) 

Article Info Abstract
Department of Neonatology, BSMMU, 

Dhaka (SS, IJ, MKHS, SC, MAM, MS, SKD); 

Upazila Health Complex, Kaliakoir,Gazi-

pur (DR)

For Correspondence:  

Sarbari Saha

Email: sarbari29th@gmail.com

Cite this ar�cle: 

Saha S, Roy D, Jahan I, Shabuj MKH,  

Choudhury S, Mannan MA,  Shahidullah 

M,  Dey SK. Frequency and outcome of 

thrombocytopenia in neonates who are 

at risk of developing thrombocytopenia - 

a prospec!ve observa!onal study. 

Bangabandhu  Sheikh  Mujib Med Univ J. 

2022; 15(2): 115-120. 

Copyright:  

The  copyright  of  this  ar!cle  is  retained 

by the author(s) [Atribu!on CC-By 4.0]   

Available at: 

www.banglajol.info  

A Journal of Bangabandhu Sheikh Mujib 

Medical University, Dhaka, Bangladesh 

Thrombocytopenia is the commonest hematological abnormality encountered in the neonatal 

intensive care unit (NICU).  This   prospective, observational study was conducted among 78 

consecutive at-risk neonates admitted in NICU, Bangabandhu Sheikh Mujib Medical                 

University (BSMMU), Dhaka from September 2016 to August 2017. Platelet count was 

measured in all at risk neonates at enrollment and less than 1,50,000/cmm was consiered as 

the cut off point for determining thrombocytopenia. Platelet count was measured every 

alternate day till discharge or normalisation of platelet count if the initial platelet count was 

low. If initial platelet count revealed normal, then the babies were followed up clinically if  

they develop any further risk condition for developing thrombocytopenia. During the period 

from enrollment to discharge, if any baby develops thrombocytopenia at any time then baby 

was defined as thrombocytopenic. Overall 39.7%patients found to be thrombocytopenic 

among 78 at-risk neonates.  Pregnancy induced hypertension (PIH), neonatal sepsis and small 

for gestational age (SGA), intra uterine growth restriction(IUGR), prematurity, necrotizing 

enterocolitis (NEC) were significantly associated with thrombocytopenia. Sepsis and NEC 

were found to be independent risk factor for thrombocytopenia. Regarding outcome, length 

of hospital stay was significantly more in thrombocytopenic patients than non-thrombocyto-

penic patients. Death rate was also higher in thrombocytopenic patients in comparison to                               

non-thrombocytopenic patients.

Received               : 20 December 2021 

Accepted              :  28 January 2022 

Available Online  :  15 May 2022

ISSN: 2224-7750 (Online)          

 2074-2908 (Print)  

DOI: h"ps://doi.org/10.3329/bsmmuj.v15i2.60866

Keywords: Thrombocytopenia, neonate, 

hematological abnormality

and in 50% of sick preterm.3  Its incidence 

reaches 70% in newborn infants with 

birth weight <1000gm.4 Thrombo- 

cytopenia is more common in certain risk 

groups such as low birth weight, 

preterm, small for gestational age, 

hypoxia at birth, umbilical line 

placement, respiratory assistance, hyper- 

bilirubinemia, phototherapy, respiratory 

distress syndrome, sepsis especially by 

candida infection, meconium aspiration, 

NEC, the mother with ITP and in a 

preterm infant with hypertensive 

mother.

Thrombocytopenia is classified as mild 

(100,000-<150,000/cmm of blood), 

moderate (50,000-<100,000/cmm) and 

severe (<50,000/cmm of blood).5  The risk 

factors for early-onset thrombocytopenia 



116 BSMMU J 2022; 15(2): 115 - 120

are pre-eclampsia, pregnancy-induced hypertension, 

intrauterine growth restriction, HELLP syndrome 

(hemolysis, elevated liver enzymes, and low platelet 

count), maternal diabetes & drug use.6 The most 

common risk factor for late-onset thrombocytopenia are 

sepsis and NEC.7 Early-onset thrombocytopenia is 

defined as thrombocytopenia that occurs before 72 hours 

of age and late-onset thrombocytopenia that occur after  

72 hours of age.8 Though thrombocytopenia is so 

prevalent it is often ignored in the surmise that it will 

resolve spontaneously. In most cases, neonatal 

thrombocytopenia is mild to moderate and can be 

resolved without intervention. However, life-threatening 

bleeding or intracranial hemorrhage (ICH) with a high 

risk of neurodevelopment impairment may occur in 

severe thrombocytopenia (platelets <50 ×109/L).9 Early 

detection and management can prevent bleeding  and 

neurological sequelae in the thrombocytopenic neonate. 

The objectives of this study were to find out the 

frequency, hospital outcome & associated factors of 

thrombocytopenia in at-risk neonates.

Methods

This observational study was carried out in NICU, 

Department of Neonatology, BSMMU,  Dhaka from 

September 2016 to August 2017. Admitted inborn 

neonates who were at-risk for developing 

thrombocytopenia and out born at-risk neonates who 

were admitted within 24 hrs of birth in NICU, BSMMU 

were included in the study. A total of 78 neonates were 

included in the study. Out born at-risk neonates who 

were admitted after 24 hours of birth, babies with major 

congenital malformation, and infants of parents who 

refused to give consent were excluded from the study. 

The at-risk newborn was defined as a newborn having 

any of the following criteria during enrollment or 

during the hospital stay i.e. positive maternal history of 

pregnancy-induced hypertension (PIH), gestational 

diabetes mellitus (GDM), maternal infection, positive 

drug history (Heparin, Hydralazine, Thiazide), & 

history of autoimmune disease (SLE, ITP). Prematurity, 

low birth weight, intrauterine growth restriction (IUGR) 

/ small for gestational age (SGA) babies, babies with 

Rh-incompatibility, neonates with a history of perinatal 

asphyxia, neonates presenting with sepsis, and 

neonates who had developed features of NEC. 

Platelet count was measured in all at-risk neonates at 

enrollment and count less than 1,50,000/cmm was 

considered as the cut-off point for determining 

thrombocytopenia. Low platelet counts were 

cross-verified by a peripheral smear study.  If the initial 

platelet count revealed normal, then the babies were 

followed-up clinically if they develop any further risk 

conditions.  If any risk condition developed i.e. sepsis, 

NEC then platelet count was repeated. If the initial 

platelet count was low, then the platelet count was 

repeated every alternate day till discharge. During the 

period from enrollment to discharge, if any baby 

developed thrombocytopenia at any time then the baby 

was labeled as thrombocytopenic group.  Those who 

never developed thrombocytopenia were labeled as 

non-thrombocytopenic group.  Standard care was given 

to all enrolled neonates as per departmental protocol. 

Treatment of thrombocytopenia consisted of 

transfusion of random donor platelet as per protocol. 

The pattern of onset of thrombocytopenia was classified 

as early if it developed <72 hours of birth and late if it 

presented after 72 hours. The severity of 

thrombocytopenia was graded as mild, moderate, and 

severe. The outcome of the enrolled neonates was 

assessed in terms of length of hospital stay, death, or 

survival.

Results

Initial platelet count was found low in 8 patients 

(10.2%). A total of 29 patients subsequently developed 

risk conditions and platelet count was measured. 

Among them, 23 revealed thrombocytopenia, and 6 

patients had normal platelet count. During the period 

from enrollment to discharge, total 31 patients were 

found thrombocytopenic.

Baseline demographic characteristics & maternal 

characteristics of thrombocytopenic and non- 

thrombocytopenic neonates were compared. 

Statistically significant difference was found in mean 

birth weight and gestational weight (p = 0.001 & 0.001 

respectively). Regarding gender and mode of delivery, 

there was no significant difference between the two 

groups. Regarding maternal characteristics, PIH was 

found significantly associated with the thrombo- 

cytopenic group (p =0.02).  While considering GDM and 

maternal infection, there was no significant difference 

between the two groups. (Table-I)



BSMMU J 2022; 15(2): 115 - 120 117

Frequency of thrombocytopenia in at risk neonate

  At risk baby 78 

  Thrombocytopenia 31

  Frequency  39.7% 

Table-II

Type of thrombocytopenia in at risk neonate

Total no of thrombocytopenic No. of   Percentage 

neonates patients (n=31) (%)

Early onset 8 25.8%

Late onset 23 74.2%

Table-III

Comparison of baseline characteristics of thrombo- 

cytopenic and non-thrombocytopenic neonates (N=78)

Characteristics Thrombocytopenic   Non-Thrombocytopenic   P-  

 group(n=31) group (n=47) value

Gestational 32.74 ± 2.1 34.76 ± 2.3 0.001

age (weeks) 

Birth weight (g) 1587 ± 514 2206± 698 <0.0001

Mode of delivery   

LUCS, n (%) 27 (84.3) 33(71.7) 0.08

NVD,   n(%) 4(15.6) 14 (28.2) 

Sex   

    Male, n (%) 15(48.4) 24(51.1) 0.817

    Female, n (%) 16(51.6) 23(48.9) 

PIH, n (%)   

Yes 16(51.6) 12(25.5) 0.02

No 15(48.3) 35(74.5) 

GDM, n (%)   

Yes 5(16.2) 12(25.5) 0.325

No 26(83.8) 35(74.5) 

Maternal infection, n (%)    

Yes                                8(25.8) 8( 17) 0.347

No 23(74.2) 39(83) 

Table-I

Changes of visual acuity of all 3(three) patient after injection methyl prednisolone

Table-IV

Among the total of 78 patients, 31 patients were found 

thrombocytopenic in this study. The frequency of 

thrombocytopenia in the at-risk neonate in NICU, 

BSMMU was found approximately 39.7% (Table-II).

According to severity, thrombocytopenic babies were 
classified as mild, moderate, and severe. Mild, 
moderate, and severe thrombocytopenia was observed 
in 22.6%, 29%, and 48.4% of neonates respectively. 
Among the 31 neonates with thrombocytopenia, 16 
(51.6%) patients had frank bleeding in various forms. GI 
bleeding was most common (56.2%). Other types of 
bleeding were skin bleeding (18 .7%) &  bleeding 
through ET tube (6.25%).  Combined Skin bleeding & GI 
bleeding was 18.7%.(Table-IV)

According to the age of onset, thrombocytopenic babies 

were classified as early and late-onset groups. Early & 

late-onset thrombocytopenia was 25.8% and 74.2% 

respectively (Table-III).

Grades of  Total no.   Percentage  Bleeding  Pattern of bleeding

thrombocytopenia (n=31) (%) menifestation 

   present 

Mild 7  22.6% no No

Moderate 9 29% 3 GI Bleeding

Severe  15  48.4% 13 Skin bleeding(3)

    GI Bleeding(6)

    Combined GI and Skin Bleeding(3)

    Bleeding through ET tube(1)

While comparing the neonatal characteristics between 

the thrombocytopenic group and the non- 

thrombocytopenic group, a statistically difference

 was found in respect to prematurity, LBW, SGA, Sepsis, 

and NEC. No statistically significant difference was 

found in asphyxia & Rh-incompatibility. (Table - V)



BSMMU J 2022; 15(2): 115 - 120118

Comparison of Neonatal characteristics among 

thrombocytopenic and non-thrombocytopenic neonates

Characteristics Thrombocytopenic   Non-Thrombocytopenic   P- 

  group(N=31) group(N= 47) Value

Prematurity, n (%)   

 Yes 31(100%) 34(72.3%) 0.001

 No  0(0.0) 13(27.7%)  

LBW, n (%)   

 Yes 27(87.1)  32(68.1)  0.047

 No 4(12.9) 15(31.9) 

SGA/IUGR, n (%)   

 Yes 11(35.5) 7(14.9) 0.035

 No  20(64.5)  40(85.1)  

Asphyxia, no (%)    

 Yes 7(22.5) 4(8.5)  0.08 

 no  24(77.4)  43(91.5) 

Sepsis, n (%)   

 Yes 25(80.6) 18(38.3) <0.001

 No   6(19.4)  29(61.7)  

NEC, n (%)     

 Yes 6(19.4)  0(0.0)  0.002

 No 25(80.6) 47(100.0) 

Rh-incompatibility, (%)    

 Yes 1(3.2) 4(8.5) 0.351

 No 30(96.7) 43(91.5) 

Table-V

Outcome of enrolled infants

Variable Thrombocytopenic   Non-Thrombocytopenic   P- 
  group (N=31) group (N= 47) Value

Prematurity, n (%)   

Length of  <14 days 11(35.5%) 29(61.7) <0.037 

hospital    >14days 20(64.5) 18(38.3) 

stay(days)  

Survival (no, %) 20(64.6) 43(91.4%) 0.007

Death (no, %) 11(35.4%)  4(8.6%) 

Table-VII

Results of multivariate regression analysis for predicting 

occurrence of thrombocytopenia 

Characteristics Odds Ratio 95%CI P value

PIH 2.1 0.642-6.919 0.219

LBW 1.4 0.272-8.174 0.645

SGA 0.451 0.111-1.83 0.266

Sepsis 4.3 1.3-14.05 0.02

Table-VI

Statistical test: Chi square test, P-value is significant <0.05

Multivariate regression analysis was done for 
predicting the association with thrombocytopenia. Only 
sepsis was found to be an independent risk factor for 
developing thrombocytopenia. (Table - VI)

Discussion

In this observational study, the frequency of 

thrombocytopenia in at risk neonates was found to be 

39.7%. In previous studies conducted in Sri Lanka and 

India, prevalence rate documented were 55% and 63% 

respectively10,11 which is much higher than this study. 

Variable prevalence rates were documented in different 

studies most probably because of wide variations in 

case inclusion, sample size and geographic variation.

Regarding demographic characteristics, mean birth 

weight was significantly lower in thrombocytopenia 

group in comparison to non-thrombocytopenia group. 

Study conducted in Tehran by Khalessi N and 

colleagues also showed similar result.12 Mean 

gestational age in this study was also lower in 

thrombocytopenia group in comparison to 

non-thrombocytopenia group. The result is consistent 

with another study which show the mean gestational 

age at birth among thrombocytopenic neonates was 

32.2±2.5 weeks which was less than the average 

gestational age at birth among all neonates (P=0.0001).12 

No statistically significant difference in gender was 

observed between neonates with and without 

thrombocytopenia in this study. Regarding mode of 

delivery, no significant difference was observed also 

between two groups in this study.

Regarding maternal characteristics, pregnancy induced 

hypertension was found significantly associated with 

thrombocytopenia. (51.6% in thrombocytopenic group 

and 25.5% in non-thrombocytopenic group). The other 

two factors GDM and maternal infection were not 

found statistically   significant.

Regarding neonatal characteristics, prematurity was 

significantly associated with thrombocytopenia. 

Among 84% of preterm baby, 47.6% had 

Regarding outcome, the number of patients who stayed  
more than 14 days in hospital was significantly higher in the 
thrombo- cytopenia group in comparison to the non- 
thrombocytopenia group. The mortality rate was also higher 
in the thrombocytopenia group than non- thrombocytopenia 
(35.4% vs 8.6%, P value-0.007). (Table - VII)



BSMMU J 2022; 15(2): 115 - 120 119

thrombocytopenia. No full term babies had 

thrombocytopenia. This may be due to the small sample 

size in this study. Prematurity is a risk factor for 

thrombocytopenia due to decreased platelet production 

and when this was associated with sepsis, the increased 

consumption of platelets further contributes to severe 

thrombocytopenia. 

LBW was significantly associated with 

thrombocytopenia in this study (p=.047). Charoo BA 

and colleagues also stated that neonatal 

thrombocytopenia was more common among low birth 

weight babies.13   However, Sharma et al showed low 

birth weight was not significantly associated with 

thrombocytopenia (P=0.47).10  Gupta and colleagues 

stated that LBW babies showed statistically significant 

thrombocytopenia due to their limited ability to 

compensate for accelerated destruction of platelets. 

Placental transport of IgG from maternal to fetal 

circulation increases with maturity and this transport is 

hampered in low birth weight babies which make them 

more prone for sepsis.14

In this study, sepsis was significantly associated with 

thrombocytopenia (P=<0.001).14  Gupta  et al observed 

that 81.5% of septic neonates developed low platelet 

counts. In studies conducted by Patil et al & Zaccheaus 

et al, sepsis was associated with severe 

thrombocytopenia with results similar to the current 

study.15,16 Among the septic neonates, 25% had positive 

blood culture. Organisms isolated from the blood of 

septic babies in order of frequency were: Klebsiella, 

Acinetobacter &  Pseudomonas.  Klebsiella was the 

most commonly isolated organism observed in study by 

Arif SH et al.17 Septicemia leads to thrombocytopenia 

due to both decreased production and increased 

consumption of platelets and hence results usually in 

severe thrombocytopenia. Sepsis also causes DIC, 

immune-mediated destruction and decreased 

production of platelets from infected marrow. In this 

study, SGA was significantly associated with 

thrombocytopenia (P=0.035).  

Maruyama H et al found growth restriction to be a 

significantly independent risk factor for 

thrombocytopenia which is consistent with our study.18 

In our study, total 5 patient had NEC and all of them 

had thrombocytopenia. In contrast to the current study, 

Sharma et al showed NEC was not significantly 

associated with thrombocytopenia (P=0.058).10 In this 

study, perinatal asphyxia was not significantly 

associated with thrombocytopenia (P=0.08). However, 

Relationship between the severity of thrombocytopenia 

and the severity and staging of hypoxic ischemic 

encephalopathy was demonstrated in study conducted 

by Nursen et al.19 Thrombocytopenia in HIE may be due 

to increased platelet destruction as mean platelet value 

was raised. In multivariate regression analysis, only 

sepsis and NEC were found to be independent risk 

factor for developing thrombocytopenia. Bonifacio L 

and colleagues observed that mucocutaneous bleeding 

complicated 18.4% of cases with severe and late-onset 

thrombocytopenia.20 In this study 16 (51.6%) of at risk 

neonates with thrombocytopenia developed bleeding. 

Von Lindern et al showed that out of all included 

neonates with thrombocytopenia, 29% received a 

platelet transfusion.21 In this study 18 (58%) high risk 

neonates with thrombocytopenia received platelet 

transfusions.

Regarding outcome, among 31 thrombocytopenic 

neonates, 11 died. Mortality rate was 35.4% compared 

to 8.6% in non-thrombocytopenic neonates. Previous 

study done by Bonifacio L et al also demonstrated that 

mortality rate among the non-thrombocytopenic 

neonates was 1.4% as compared to 16.7%, 32.4%, and 

45.8% in preterm neonates with mild, moderate and 

severe thrombocytopenia respectively.20  In another 

study done by Sola MC et al, incidence of mortality was 

found to be 34% in preterm neonates.22

Conclusion

Frequency of thrombocytopenia in at risk neonate in 

NICU, BSMMU was approximately 39.7%. Prematurity, 

LBW, PIH, sepsis and SGA/IUGR, NEC were 

significantly associated with thrombocytopenia. 

Duration of hospital stay and mortality rate were higher 

in thrombocytopenic neonates than non- thrombo- 

cytopenic neonates and survival rate was higher in 

non-thrombocytopenic neonates than thrombo- 

cytopenic neonates among at risk neonates.

As the prevalence of neonatal thrombocytopenia is 

high, it is important to look for platelet count, severity, 

degree and pattern of onset of thrombocytopenia in 

each and every case of at risk neonates admitted to 

NICU, which will help the clinician in diagnosis, 

planning investigations and aid in appropriate 

management & improve outcome. A large sample, 

multicenter study should be conducted to support the 

current study 



BSMMU J 2022; 15(2): 115 - 120120

References

1.  Roberts I, Murray NA. Neonatal thrombocytopenia: 

causes and management. Archives of Disease in 

Childhood-Fetal and Neonatal Edition. 2003; 88(5): 

F359-64.

2.  Veneri D,  Franchini M, Randon F, Nichele I, Pizzolo G, 

Ambrosetti A. Thrombocytopenias: a clinical point of 

view. Blood Transfusion. 2009;7(2):75.

3.  Roberts IA, Murray NA. Neonatal thrombocytopenia: 

new insights into pathogenesis and implications for 

clinical management. Current  opinion in pediatrics. 

2001;13(1):16-21.

4.  Gomella TL, Cunningham MD, Eyal FG,  Tuttle DJ. 

Neonatology management, procedure, on-call problems, 

disease and drugs. Seventh ed. New York: McGraw Hill; 

2013. 334p.

5.  Gupta A, Mathai SS, Kanitkar M. Incidence of 

thrombocytopenia in the neonatal intensive care unit. 

Medical Journal Armed Forces India. 2011 Jul 

1;67(3):234-6.

6.  Eslami Z, Lookzadeh MH, Noorishadkam M, Hashemi A, 

Ghilian R, Pirdehghan A. Thrombocytopenia and 

associated factors in neonates admitted to NICU during 

years 2010_2011. Iranian journal of  pediatric hematology 

and oncology. 2013;3(1):205. 

7.  Murray NA, Howarth LJ, McCloy MP, Letsky EA, Roberts 

IA. Platelet transfusion in the management of severe in  

intensive care unit patients.Transfusion medicine. 2002 

Feb;12 (1):35-41.

8.  Rennie MJ. Rennie & Roberton’s Textbook of 

Neonatology. 5th Ed. New York: Churchill Livingstone, 

Elsevier; 2012. 777p

9.  Holzhauer S, Zieger B (2011).Diagnosis and management 

of neonatal thrombocytopenia. Semin Fetal Neonatal 

Med.2011 Jan ; 16(6):305-10.

10.  Sharma A, Thapar K. A prospective   observational study 

of thrombocytopenia in high risk neonates in a tertiary 

care teaching hospital. Sri Lanka Journal of Child Health. 

2015;44(4).

11.  Sonam, S, Nandyal, Shashikala , Vidushi, Sehgal. Study of 

thrombocytopenia in neonatal intensive care unit. Indian 

Journal of Pathology and Oncology.2016 ;3(1):55-59

12. Sanii S, Khalessi N, Khosravi N, ZarehMehrjerdi F. The 

prevalence and risk factors for neonatal thrombocytopenia 

among newborns admitted to intensive care unit of 

Aliasghar children’s hospital. Iranian J Blood Cancer. 2013 

;5(2):41-5

13. Charoo BA, Iqbal J, Iqbal Q, Mushtaq S, Bhat AW, Nawaz 

I. Nosocomial sepsis-induced late onset thrombocytopenia 

in a neonatal tertiary care unit: a prospective study. 

Hematology/oncology and stem cell therapy.  2009; 2(2): 

349-53.

14.  Gupta, AK, Kumari, S, Singhal A, BahlA.Neonatal 

thrombocytopenia and platelet transfusion. Asian Journal 

of Transfusion Science.2012 ;6(2):161-4.

15.  Patil S, Mangshetty R, Patil B. Outcome of neonates with 

thrombocytopenia. Journal of Evolution of Medical and 

Dental Sciences. 2014 ;3(17):4533-9.

16. Jeremiah ZA, Oburu JE. Pattern and prevalence of neonatal 

thrombocytopenia in Port Harcourt, Nigeria. Pathology  

and laboratory medicine international. 2010 ;2:27-31.

17.  Arif SH, Ahmad I, Ali SM, Khan HM. Thrombocytopenia 

and bacterial sepsis in neonates. Indian Journal of 

Hematology and Blood Transfusion. 2012 ;28(3):147-

18. Maruyama H, Shinozuka M, Kondoh YI, Akahori YI, 

Matsuda M, Inoue S, Sumida Y, Morishima T. 

Thrombocytopenia in preterm infants with intrauterine 

growth restriction. Actamedica Okayama. 2008;62(5):313-7.

19.  Nursen B, Sukru K, Recep S, Serap U. Perinatal asphyxia 

and thrombocytopenia. OMU Tip Derg. 1999;16(2):100-5.

20.  Bonifacio L, Petrova A, Nanjundaswamy S, Mehta R. 

Thrombocytopenia related neonatal outcome in preterms. 

The Indian Journal of Pediatrics. 2007;74(3):269-74.

21.  Von Lindern JS, van den Bruele T, Lopriore E, Walther FJ. 

Thrombocytopenia in neonates and the risk of intra- 

ventricular hemorrhage: a retrospective cohort study. 

BMC pediatrics. 2011;11(1):1-7.

22.  Sola MC, Del Vecchio A, Rimsza LM. Evaluation and 

treatment of thrombocytopenia in the neonatal intensive 

care  unit. Clinics in  perinatology. 2000;27(3):655-79.


