ABSTRACT
Background: Thrombocytopenia as a side effect of phototherapy has not been mentioned in the standard literature but was described briefly as isolated case reports after the phototherapy came in vogue in 1958. The purpose of this study was to find the incidence of thrombocytopenia in neonates with uncomplicated indirect hyperbilirubinemia receiving phototherapy in a referral hospital.Methods: This was a prospective cohort study conducted in a referral hospital over a period of 18 months from June 1, 2013 to November 1, 2014.Results: A total of 103 babies were enrolled. The overall incidence of post-phototherapy thrombocytopenia was 45.6% while mild, moderate and severe thrombocytopenia was present in 66%, 21.3% and 12.8% of babies respectively. The lowest platelet count observed was 31,000/mm3 but none of the neonates showed bleeding manifestations. The incidence of thrombocytopenia following phototherapy was significantly higher in preterm babies, infants who received double surface phototherapy, babies who received phototherapy for >72 hours and in babies who received phototherapy on day 2 or 3 of life.Conclusions: Neonates requiring phototherapy for hyperbilirubinemia are at risk of developing thrombocytopenia, hence the treatment should be initiated based on the standard guidelines. Unnecessary use and prolongation of phototherapy should be avoided considering the possible side effects. Platelet count should be monitored particularly in pre-term neonates receiving phototherapy. Neonates receiving double surface phototherapy and those requiring phototherapy for longer duration require more frequent platelet count monitoring.
ABSTRACT
Background: Despite changes in nutritional interventions in neonatal intensive care units worldwide, significant proportion of preterm babies are growth restricted at discharge. Authors intended to look at the feasibility of aggressive nutrition bundle (aggressive parenteral nutrition, standardized feeding policy, fortification and probiotics) in preterm neonates.Methods: This single centre prospective analytical cohort study, involving babies born before 34 weeks of gestation, was conducted in a tertiary hospital. Aggressive parenteral nutrition and enteral nutrition bundle intervention was started within 24 hours of birth. Clinical, laboratory and anthropometrical parameters were monitored longitudinally to ensure safety of this intervention.Results: Mean gestational age and birth weight of the cohort (n=107) was 30.6 weeks (SD'2.6) and 1147 grams (SD'287) respectively. Out of 107 babies, 67.3% (n=72) have extra uterine growth retardation (EUGR) at discharge and was more in small for gestational age neonates (p=0.001). With this aggressive parenteral and enteral nutrition bundle intervention, medical necrotizing enterocolitis (NEC) developed in 7.4 % (n=8) babies while surgical NEC was seen in 1.9%. (n=2). Early onset and late-onset sepsis occurred in 1.8% and 5.4% of babies respectively while mild hyperammonemia, mild hypertriglyceridemia, raised creatinine and urea developed in 12.4%, 4.6%, 7.4% and 11.7% respectively. Hyperglycemia and hypoglycemia were present in 8.8% and 5.6% babies respectively.Conclusions: Aggressive nutrition bundle (aggressive parenteral nutrition, standardized feeding policy, fortification and probiotics) can be safely employed in preterm babies. There is an urgent need to design a study to see the impact of this approach on incidence of EUGR in preterm babies.