Investigation of risk factors and prognosis in patients with bicitopenia / pancytopenia in A newborn intensive care unit

Background and Aim: Neonatal anemia, neutropenia, and thrombocytopenia are common hematological problems in neonatal intensive care units, especially in preterm and low birth weight newborns. Newborns are one of the most transfused patient groups. In the literature, there are studies evaluating neonatal anemia, thrombocytopenia and neutropenia separately, but there is no study on neonatal bicytopenia and pancytopenia yet. In our study, we aimed to reduce the frequency of pancytopenia / bicytopenia by eliminating preventable causes by determining the causes and risk factors that cause pancytopenia / bicytopenia and to evaluate the treatment and clinical follow-up results in cytopenic newborns. Materials and Methods: 2672 patients hospitalized in the neonatal 1st, 2nd and 3rd level intensive care units of Dokuz Eylül University Medical Faculty Hospital between 01/01/2015 and 31/12/2018 were retrospectively analyzed in terms of developing bicytopenia / pancytopenia in the first month of life. Demographic characteristics, laboratory findings and clinical characteristics of the patients were recorded. Findings: The prevalence of bicytopenia in was 3.4%; the prevalence of pancytopenia was found to be 0.4%. Among the antenatal and natal risk factors, preterm delivery, asphytic delivery and low birth weight were risk factors for bicytopenia and pancytopenia; cesarean delivery and gestational hypertension were found to be risk factors for bicytopenia. Gender, maternal age, premature rupture of membranes, gestational diabetes, and maternal rheumatologic disease were not among risk factors for bicytopenia / pancytopenia. The most common cause of bicytopenia and pancytopenia was sepsis. The median first detection day of bicytopenia was the 6th day, nadir day was the 6th day, and the recovery day was the 3rd day after the onset of bicytopenia The median onset day of pancytopenia was the 5th day, nadir day was the 6th day, and the recovery day was the 7th day after the onset of pancytopenia. Bicytopenia / pancytopenia reoccured in 4.9% of the patients within the first month. The mean number of transfusions (erythrocyte and platelet suspension) in bicytopenic patients was 2.16 and was 5.64 in pancytopenic patients. A significant association was found between the number of transfusions and recovery days, but it was found that the number of transfusions was not associated with reoccurrence. Bleeding symptoms and the need for erythrocyte suspension were high in patients who needed mechanical ventilation. Among neonates with bicytopenia and pancytopenia 4,8% had severe anemia and 32% had severe thrombocytopenia. The presence of severe anemia, severe thrombocytopenia and the need for mechanical ventilation were found to be poor prognostic factors leading to a prolonged recovery period. It was observed that 15.2% of bicytopenic patients and 27.3% of pancytopenic patients were dead. Sepsis was the most common cause of death in these patients. Results: Development of bicytopenia and pancytopenia was common especially in preterm and low birth weight infants hospitalized in the neonatal intensive care units, and the mortality rate was quite high in these newborns. It has been observed that being preterm, low birth weight, asphyxia and gestational hypertension were risk factors for cytopenia. It was found that the recovery period was longer in cases with severe anemia, severe thrombocytopenia and needed mechanical ventilation. Since sepsis was the most common cause of bicytopenia/ pancytopenia and mortality in these neonates, incidence of bicytopenia/ pancytopenia and mortality can be decreased by increasing preventive measures, providing early diagnosis and effective treatement. Keywords: Newborn, pancytopenia, bicytopenia, prognosis