Platelet parameters are associated with severe complications and length of hospital stay in very low birth weight infants

doi:10.3877/cma.j.issn.1674-0785.2021.02.002

Abstract

Abstract:

Objective

To investigate the correlation between platelet parameters of very low birth weight infants and severe complications and length of hospital stay in premature infants, and to explore whether platelet parameters are helpful to reflect the occurrence of severe complications in premature infants and predict the length of hospital stay.

Methods

General conditions, clinical characteristics, and platelet parameters [platelet (PLT), platelet mean volume (MPV), platelet distribution width (PDW), and platelet quality index (PMI)] on the first day of after birth of very low birth weight infants admitted to the Neonatal Department of Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2016 to June 2020 were retrospectively analyzed. Children with intracerebral hemorrhage (IVH), bronchopulmonary dysplasia (BPD) and necrotizing enterocolitis (NEC) were grouped by different degree of disease and correct gestational age at discharge grouping, the clinical features and platelet parameters were compared. Multivariate Logistic regression was used to analyze the correlation between platelet parameters and these 3 diseases, and the ROC curve was used to study its predictive value for moderate to severe complications and length of hospital stay in premature infants.

Results

A total of 177 children with very low birth weight were included, the incidence of moderate to severe IVH, moderate to severe BPD and moderate to severe NEC respectively were 8.5%, 22.0%, 5.1%. (1) PMI of the moderate and severe IVH group was significantly lower than that of the non-moderate and severe IVH group, and PMI was an independent risk factor for developing moderate to severe IVH in children with very low birth weight (OR=0.008, 95%CI: 0.000-0.255, P=0.021). The AUC predicted by PMI was 0.825 (95%CI: 0.744-0.905, P＜0.001), and the optimal cut-off point was 1.77 fl/nl. (2) MPV of moderate and severe BPD group was significantly higher than that of non-moderate and severe BPD group, which was an independent risk factor for the occurrence of moderate and severe BPD (OR=3.613, 95%CI: 1.840-7.095, P＜0.001). The AUC predicted by MPV was 0.784 (95%CI: 0.704-0.865, P＜0.001), and the optimal cut-off point was 11.05 fl. (3) MPV of group with long hospital stay was higher than group with short hospital stay, after adjusting for multiple factors, such as gestational age, mother gestational hypertension, gestational HELLP syndrome, premature rupture of membranes, moderate and severe BPD, moderate and severe NEC, higher MPV was an independent risk factor for long hospital stay (OR=2.052, 95%CI: 1.307-3.221, P=0.002). The AUC of long hospital stay predicted by MPV was 0.656 (95%CI: 0.548-0.763, P=0.002). The sensitivity was 54% and specificity was 82%, when the cut-off point was 11.35 fl.

Conclusion

Platelet parameters on the first day after birth are associated with severe complications and length of hospital stay in premature infants. PMI was associated with moderate to severe IVH, MPV was associated with moderate to severe BPD and length of hospital stay. Monitoring platelet parameters on the first day after birth may be of certain value for prognosis assessment.

Key words: Very low birth weight, Platelet parameters, Length of hospital stay, Complications of premature infants

Ying Chen, Di Zhang, Xiaoying Wang, Xiaoyan Peng, Tongying Han, Liang Chen, Shenghua Jia, Li Li. Platelet parameters are associated with severe complications and length of hospital stay in very low birth weight infants[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(02): 87-94.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2021.02.002

https://zhlcyszz.cma-cmc.com.cn/EN/Y2021/V15/I02/87

Figures/Tables 6

组别	例数	胎龄[周，M（Q₁，Q₃）]	剖腹产[例（%）]	1 min Apgar评分[分，M（Q₁，Q₃）]	5 min Apgar评分[分，M（Q₁，Q₃）]	母亲GDM[例（%）]	PLT（×10⁹/L， $x ¯$ ±s）	PMI（fl/nl ， $x ¯$ ±s）
非中重度IVH组	162	30（29，31）	114（70.4）	9（8，9）	9（9，10）	25（15.4）	208±68	2.27±0.74
中重度IVH组	15	29（27，30）	9 （60.0）	7（2，8）	9（7，9）	9（60.0）	136±48	1.45±0.47
单因素分析统计值		Z=-2.594	χ²=-3.058	Z=-3.590	Z=-3.690	χ²=17.570	t=5.223	t=5.995
P值		0.009	0.002	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
多因素分析 P值		0.031	0.470	0.020	0.203	0.013	0.052	0.021

组别	例数	胎龄[周，M（Q₁，Q₃）]	剖腹产[例（%）]	1 min Apgar评分[分，M（Q₁，Q₃）]	5 min Apgar评分[分，M（Q₁，Q₃）]	母亲GDM[例（%）]	PLT（×10⁹/L， $x ¯$ ±s）	PMI（fl/nl ， $x ¯$ ±s）
非中重度IVH组	162	30（29，31）	114（70.4）	9（8，9）	9（9，10）	25（15.4）	208±68	2.27±0.74
中重度IVH组	15	29（27，30）	9 （60.0）	7（2，8）	9（7，9）	9（60.0）	136±48	1.45±0.47
单因素分析统计值		Z=-2.594	χ²=-3.058	Z=-3.590	Z=-3.690	χ²=17.570	t=5.223	t=5.995
P值		0.009	0.002	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
多因素分析 P值		0.031	0.470	0.020	0.203	0.013	0.052	0.021

组别	例数	胎龄[周，M（Q₁，Q₃）]	出生体重[g，M（Q₁，Q₃）]	小于胎龄儿[例（%）]	气管插管[例（%）]	1 min Apgar 评分[分，M（Q_1,Q₃）]	MPV（fl， $x ¯$ ±s）	PDW（%， $x ¯$ ±s）
非中重度BPD组	138	30（29，31）	1390（1205，1461）	20（14.5）	95（68.8）	9（8，9）	10.41±0.91	11.72±1.60
中重度BPD组	39	28（27，29）	1096（1000，1210）	1（2.6）	39（100.0）	8（4，9）	11.47±0.99	12.70±2.43
单因素分析统计值		Z=-7.117	Z=-5.703	χ²=4.138	χ²=16.052	Z=-3.336	t=-6.025	t=-2.382
P值		＜0.001	＜0.001	0.049	＜0.001	0.001	＜0.001	0.021
多因素分析 P值		＜0.001	0.376	0.182	0.997	0.003	＜0.001	0.053

组别	例数	胎龄[周，M（Q₁，Q₃）]	出生体重[g，M（Q₁，Q₃）]	小于胎龄儿[例（%）]	气管插管[例（%）]	1 min Apgar 评分[分，M（Q_1,Q₃）]	MPV（fl， $x ¯$ ±s）	PDW（%， $x ¯$ ±s）
非中重度BPD组	138	30（29，31）	1390（1205，1461）	20（14.5）	95（68.8）	9（8，9）	10.41±0.91	11.72±1.60
中重度BPD组	39	28（27，29）	1096（1000，1210）	1（2.6）	39（100.0）	8（4，9）	11.47±0.99	12.70±2.43
单因素分析统计值		Z=-7.117	Z=-5.703	χ²=4.138	χ²=16.052	Z=-3.336	t=-6.025	t=-2.382
P值		＜0.001	＜0.001	0.049	＜0.001	0.001	＜0.001	0.021
多因素分析 P值		＜0.001	0.376	0.182	0.997	0.003	＜0.001	0.053

项目	住院时间短组(134例）	住院时间长组（43例）	统计值	P值
男性[例（%）]	60（44.8）	18（41.9）	χ²=1.112	0.860
胎龄[周，M（Q₁，Q₃）]	30（28，31）	30（29，33）	Z=-2.284	0.022
出生体重[g，M（Q₁，Q₃）]	1380（1147，1452）	1285（1050，1440）	Z=-1.332	0.183
剖腹产[例（%）]	89（66.4）	34（79.1）	χ²=2.458	1.131
SGA[例（%）]	9（6.7）	12（27.9）	χ²=13.979	0.001
1 min Apgar 评分[分，M（Q₁，Q₃）]	9（8，9）	8（7，9）	t=-1.523	0.128
5 min Apgar 评分[分，M（Q₁，Q₃）]	9（9，10）	9（9，10）	t=-0.701	0.483
产前类固醇[例（%）]	116（86.6）	36（83.7）	χ²=0.217	0.622
气管插管[例（%）]	103（76.9）	31（72.1）	χ²=0.403	0.544
母亲PIH[例（%）]	42（31.3）	21（48.8）	Z=4.346	0.045
母亲GDM[例（%）]	25（18.7）	9（20.9）	χ²=0.108	0.824
HELLP综合征[例（%）]	44（32.8）	6（14.0）	χ²=5.726	0.019
胎盘早剥[例（%）]	5（3.7）	5（11.6）	χ²=3.808	0.064
PROM（≥18 h）[例（%）]	44 （32.8）	6（14.0）	χ²=5.726	0.019
中重度IVH[例（%）]	12（9.0）	3（7.0）	χ²=0.164	0.767
中重度BPD[例（%）]	24（18.0）	15（34.9）	χ²=5.459	0.019
败血症[例（%）]	51（38.1）	23（53.5）	χ²=3.185	0.074
中重度NEC[例（%）]	4（3.0）	5（11.6）	χ²=4.977	0.040
PLT（×10⁹/L， $x ¯$ ±s）	208±72	185±59	t=2.081	0.040
MPV（fl， $x ¯$ ±s）	10.47±0.87	11.20±1.27	t=-3.493	0.001
PDW（%， $x ¯$ ±s）	11.77±1.58	12.47±2.47	t=-1.737	0.088
PMI（fl/nl， $x ¯$ ±s）	2.23±0.77	2.11±0.71	t=0.947	0.347

项目	住院时间短组(134例）	住院时间长组（43例）	统计值	P值
男性[例（%）]	60（44.8）	18（41.9）	χ²=1.112	0.860
胎龄[周，M（Q₁，Q₃）]	30（28，31）	30（29，33）	Z=-2.284	0.022
出生体重[g，M（Q₁，Q₃）]	1380（1147，1452）	1285（1050，1440）	Z=-1.332	0.183
剖腹产[例（%）]	89（66.4）	34（79.1）	χ²=2.458	1.131
SGA[例（%）]	9（6.7）	12（27.9）	χ²=13.979	0.001
1 min Apgar 评分[分，M（Q₁，Q₃）]	9（8，9）	8（7，9）	t=-1.523	0.128
5 min Apgar 评分[分，M（Q₁，Q₃）]	9（9，10）	9（9，10）	t=-0.701	0.483
产前类固醇[例（%）]	116（86.6）	36（83.7）	χ²=0.217	0.622
气管插管[例（%）]	103（76.9）	31（72.1）	χ²=0.403	0.544
母亲PIH[例（%）]	42（31.3）	21（48.8）	Z=4.346	0.045
母亲GDM[例（%）]	25（18.7）	9（20.9）	χ²=0.108	0.824
HELLP综合征[例（%）]	44（32.8）	6（14.0）	χ²=5.726	0.019
胎盘早剥[例（%）]	5（3.7）	5（11.6）	χ²=3.808	0.064
PROM（≥18 h）[例（%）]	44 （32.8）	6（14.0）	χ²=5.726	0.019
中重度IVH[例（%）]	12（9.0）	3（7.0）	χ²=0.164	0.767
中重度BPD[例（%）]	24（18.0）	15（34.9）	χ²=5.459	0.019
败血症[例（%）]	51（38.1）	23（53.5）	χ²=3.185	0.074
中重度NEC[例（%）]	4（3.0）	5（11.6）	χ²=4.977	0.040
PLT（×10⁹/L， $x ¯$ ±s）	208±72	185±59	t=2.081	0.040
MPV（fl， $x ¯$ ±s）	10.47±0.87	11.20±1.27	t=-3.493	0.001
PDW（%， $x ¯$ ±s）	11.77±1.58	12.47±2.47	t=-1.737	0.088
PMI（fl/nl， $x ¯$ ±s）	2.23±0.77	2.11±0.71	t=0.947	0.347

因素	回归系数	Waldχ²值	OR值	95%CI	P值
胎龄	0.479	8.174	1.615	1.163~2.243	0.004
小于胎龄儿	1.059	2.420	2.885	0.759~10.958	0.120
高血压	0.205	0.191	1.228	0.488~3.088	0.662
HELLP综合征	0.322	0.299	1.381	0.435~4.386	0.585
胎膜早破（≥18 h）	-0.708	1.499	0.493	0.159~1.530	0.221
中重度BPD	1.405	4.543	4.077	1.120~14.846	0.033
中重度NEC	1.551	3.973	4.715	1.026~21.662	0.046
PLT	-0.004	1.031	0.996	0.990~1.003	0.310
MPV	0.719	9.762	2.052	1.307~3.221	0.002

项目	临界值	AUC（95%CI）	敏感度（%）	特异度（%）	P值
PMI预测中重度IVH	1.77 fl/nl	0.825（0.744~0.905）	75	73	0.000
MPV预测中重度BPD	11.05 fl	0.784（0.704~0.865）	74	76	0.000
MPV预测住院时长	11.35 fl	0.656（0.548~0.763）	54	82	0.002

References 30

1	Howson CP, Kinney MV, Mcdougall L, et al. Born too soon: preterm birth matters [J]. Reprod Health, 2013, 10Suppl 1(Suppl 1): S1.
2	Shim JW, Jin HS, Bae CW. Changes in survival rate for very-low-birth-weight infants in Korea: comparison with other countries [J]. J Korean Med Sci, 2015, 30(Suppl 1): S25-S34.
3	崔浩, 何春花, 缪蕾, 等. 1996-2013年中国早产或低出生体重儿死亡率变化趋势分析 [J]. 中华预防医学杂志, 2015, 49(2) :161-165.
4	Go H, Ohto H, Nollet KE, et al. Using platelet parameters to anticipate morbidity and mortality among preterm neonates: a retrospective study [J]. Front Pediatr, 2020, 8: 90.
5	Okur N, Buyuktiryaki M, Uras N, et al. Platelet mass index in very preterm infants: can it be used as a parameter for neonatal morbidities? [J]. J Matern Fetal Neonatal Med, 2016, 29(19): 3218-3222.
6	Cekmez F, Tanju IA, Canpolat FE, et al. Mean platelet volume in very preterm infants: a predictor of morbidities?[J]. Eur Rev Med Pharmacol Sci, 2013, 17(1): 134-137.
7	邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学 [M]. 5版. 北京: 人民卫生出版社, 2019: 632-639.
8	张茜, 程欣茹, 盛光耀. 血小板活化因子与新生儿疾病 [J]. 实用儿科临床杂志, 2011, 26(24): 1893-1895.
9	Shaaban HA, Safwat N. Mean platelet volume in preterm: a predictor of early onset neonatal sepsis [J]. J Matern Fetal Neonatal Med, 2020, 33(2): 206-211.
10	Bolouki MK, Zarkesh M, Kamali A, et al. The association of mean platelet volume with intra ventricular hemorrhage and broncho pulmonary dysplasia in preterm infants [J]. Iran J Ped Hematol Oncol, 2015, 5(4): 227-232.
11	Ilhan O, Bor M. Platelet mass index and prediction of severity of transient tachypnea of the newborn [J]. Pediatr Int, 2019, 61(7): 697-705.
12	Kahvecioglu D, Erdeve O, Akduman H, et al. Influence of platelet count, platelet mass index, and platelet function on the spontaneous closure of ductus arteriosus in the prematurity [J]. Pediatr Neonatol, 2018, 59(1): 53-57.
13	Grevsen AK, Hviid C, Hansen AK, et al. The role of platelets in premature neonates with intraventricular hemorrhage: a systematic review and meta-analysis [J]. Semin Thromb Hemost, 2020, 46(3): 366-378.
14	Korkmaz L, Bastug O, Ozdemir A, et al. Can platelet mass index be a parameter to predict intraventricular hemorrhage in very-low-birth-weight newborns? [J]. Am J Perinatol, 2019, 36(11): 1188-1197.
15	Mitsiakos G, Papathanasiou AE, Kyriakidis I, et al. Intraventricular hemorrhage and platelet indices in extremely premature neonates [J]. J Pediatr Hematol Oncol, 2016, 38(7): 533-538.
16	Zisk JL, Mackley A, Christensen RD, et al. Is a small platelet mass associated with intraventricular hemorrhage in very low-birth-weight infants? [J]. J Perinatol, 2011, 31(12):776-779.
17	赵婧, 许玉霞, 皮光环, 等. 血小板减少症对新生儿脑室内出血的影响分析 [J]. 中国实用儿科杂志, 2014, 29(5): 380-383.
18	Holinstat M. Normal platelet function [J]. Cancer Metastasis Rev, 2017, 36(2): 195-198.
19	Chu SG, Becker RC, Berger PB, et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis [J]. J Thromb Haemost, 2010, 8(1):148-156.
20	Wedzicha JA, Cotter FE, Empey DW. Platelet size in patients with chronic airflow obstruction with and without hypoxaemia [J]. Thorax, 1988, 43(1): 61-64.
21	Dani C, Poggi C, Barp J, et al. Mean platelet volume and risk of bronchopulmonary dysplasia and intraventricular hemorrhage in extremely preterm infants [J]. Am J Perinatol, 2011, 28(7): 551-556.
22	付培培, 谢萌, 崔红. 早产儿支气管肺发育不良形成过程中血小板动态监测 [J]. 中国儿童保健杂志, 2019, 27(6): 656-659.
23	程萍, 余增渊, 孙慧清. 平均血小板体积与新生儿坏死性小肠结肠炎预后不良的关系 [J]. 中华新生儿科杂志(中英文), 2019, 34(6): 453-455.
24	王娟. 血小板活化在新生儿坏死性小肠结肠炎中的早期诊断价值 [D]. 天津: 天津医科大学, 2009.
25	Namachivayam K, Mohankumar K, Garg L, et al. Neonatal mice with necrotizing enterocolitis-like injury develop thrombocytopenia despite increased megakaryopoiesis [J]. Pediatr Res, 2017, 81(5): 817-824.
26	Miner CA, Fullmer S, Eggett DL, et al. Factors affecting the severity of necrotizing enterocolitis [J]. J Matern Fetal Neonatal Med, 2013, 26(17): 1715-1719.
27	Greisenegger S, Endler G, Hsieh K, et al. Is elevated mean platelet volume associated with a worse outcome in patients with acute ischemic cerebrovascular events? [J]. Stroke, 2004, 35(7): 1688-1691.
28	Cui M M, Li N, Liu X, et al. Platelet distribution width correlates with prognosis of non-small cell lung cancer [J]. Sci Rep, 2017, 7(1): 3456.
29	Gu X, Fu X, Wang Y, et al. Comparison of ticagrelor and high-dose clopidogrel on the platelet functions in patients with inadequate response to clopidogrel [J]. Am J Cardiovasc Dis, 2017, 7(1): 1-8.
30	Golwala ZM, Shah H, Gupta N, et al. Mean platelet volume (MPV), platelet distribution width (PDW), platelet count and plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control study [J]. Afr Health Sci, 2016, 16(2): 356-362.

[1]	Cong Li, Yan Xu, Ming Wu, Ruidong Ding, Jun Wang. Relationship between serum 25(OH)D levels at birth and early feeding intolerance in very low birth weight infants [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(03): 309-314.
[2]	Lei Li, Huike Bai, Yiling Jiang, Chen Wu, Wanting Xu, Li Liu, Deyuan Li. The role of 2 modes of mechanical ventilation for respiratory support in very low birth weight preterm infants with respiratory distress syndrome [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(02): 198-204.
[3]	Jingfang Zhai, Jiebin Wu, Xiao Liu, bao Jin, Yanbo Wang, Yang Chen, Yun Wang, Guangling Zhou, Bin Zhou. Application of noninvasive high frequency oscillation ventilation in initial respiratory support of very low birth weight premature infants with respiratory distress syndrome [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(05): 598-605.
[4]	Lijuan Long, Hongjuan Bi, Yisi Huang, Qiufen Wei, Liping Yao. Analysis of clinical characteristics of parenteral nutrition associated cholestasis in very/extremely low birth weight infants [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(05): 545-551.
[5]	Jinhui Li, Dezhi Mu. Hot issues in clinical management of premature infants [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(01): 1-7.
[6]	Ying Yang, Qin Zhou, Shanyu Jiang, Min Wang, Yingzi Mei, Renqiang Yu. Clinical significance of oral immune therapy with colostrum on reducing incidence of nosocomial infection in very low birth weight preterm infants [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2019, 15(05): 535-540.
[7]	Yan Mo, Yujun Chen, Qiufen Wei, Yan Li, Xinnian Pan. Analysis of risk factors for bronchopulmonary dysplasia in very low birth weight preterm infants [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2019, 15(03): 320-327.
[8]	Lin Zhang, Xiaoyan Yang, Jing Shi. Analysis of influencing factors of very low birth weight infants with bronchopulmonary dysplasia [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(05): 518-523.
[9]	Yong Hu, Jun Tang, Bin Xia, Dezhi Mu. Clinical analysis of 1 146 cases of very/extremely low birth weight infants [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(02): 149-155.
[10]	Jun Yang, Shuixia Li, Lina Chen. Clinical analysis of risk factors of parenteral nutrition-associated cholestasis in very low birthweight infants [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2015, 11(05): 559-563.
[11]	Hongxin Li, Dehong Hou, Wenjuan Tu, Qinfen Zhang, Peng Xie, Wei Wu. Application of fecal calprotectin in diagnosing necrotizing enterocolitis of very low birth weight infants [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2015, 11(03): 356-360.
[12]	Mingyu Li, Jun Tang, Jinlin Wu, Dezhi Mu. Clinical Analysis of Very Low Birth Weight Infants and Extremely Birth Weight Infants [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2014, 10(03): 314-319.
[13]	Yu-lan LI, Min-shu ZOU, Hong-zhu LU, Lin WANG, Shao-hua ZHOU, Qi-hong FAN, Ben-xin GONG. Sleep Problems Among the Children Aged 7-13 Years Old With Very Low Birth Weight in Jingzhou, Hubei Province [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2011, 07(04): 332-334.
[14]	Chuang Jiang, Mingheng Liao, Yong Zeng. Effect of diabetes mellitus on perioperative conditions of patients undergoing hepatectomy [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(01): 82-86.

Please choose a citation manager

Content to export