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Friday, March 7, 2014
Newborn and Infant Care
My grandson is two days old and can not go home due to low platelets. Whay exactly does that mean and what can cause this. He was born with a slight fever which is now normal as well as some liquid from the womb in his lungs. Please help me understand this. Thank you.
The most common cause of low platelets is infection. Newborns have very immature immune systems and rely mainly on antibodies from their mothers to protect them from illness. The newborn's ability to respond to bacterial infections by producing large numbers of bacteria killing cells is easily overwhelmed by rapidly multiplying bacteria. The blood cells that help to kill and inactivate bacteria are the white blood cells. Platelets are also produced from the earliest form of the white blood cell. Their is principally in helping blood to clot. So when white blood cells are consumed in their efforts to fight infection and their numbers drop, so do the numbers of platelets.
Platelets can also be consumed as the body tries to fight bacterial infection. The inflammation caused by infection causes blood cells to leak out of the blood vessels in the lungs and other areas of the body as the infection becomes stronger. These small areas of bleeding attract platelets to stop it by forming a clot. This is usually a sign of a severe infection.
The slight fever your grandson had was an indication that his body was responding to the bacterial invader by trying to create a hostile environment for bacterial multiplication. It is actually a positive sign that his body was able to produce a fever. The sickest babies' bodies are so ill they are actually cold.
Bacteria that make newborns ill come from many sources. They may come from an infection their mother has and may not even fill ill from, they come from prolonged rupture of the membranes before birth, contamination in the birth canal, or contamination from instruments or internal monitoring devices used during labor.
It is wonderful news that your grandson is responding quickly to antibiotics. Hopefully his immune system will now recover quickly and replenish both his white cells and platelets. Doctors would not want a new baby to go home with a low platelet count in case severe bleeding were to occur. Low white cell counts would place the baby at great risk of acquiring another infection soon after the first one with possibly less ability to fight the infection. Doctors also will likely test to make sure that the baby does not have newborn leukemia. This is very rare. Some babies also produce antibodies against their own platelets, literally killing their own clotting cells, and some babies have acquired antibodies from their mothers that destroy their platelets. Both of these problems are quite rare.
It's a good idea to ask the nurses to help you understand all of the blood tests, medications, treatments, and precautions needed to help your grandson overcome this bump in the road after birth. Keep asking for explanations until you feel you do understand what is happening and why. The NICU can be a very overwhelming place that adds to the stress of having a sick baby, making it difficult to grasp information and hold onto it. Nurses understand this and are willing to help. So don't hesitate to ask.
I hope this information is helpful.
Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University