Petechiae are common in newborns with fetal and neonatal alloimmune thrombocytopenia (FNAIT).
Small red or purple spots are visible on the newborn’s skin as a result of the rupture of tiny blood vessels, or bleeding under the skin. They are a key indicator of FNAIT in a newborn and need to be queried, leading to further testing. Urgent treatment will be required if further symptoms are detected and platelet levels are very low.
Symptoms of FNAIT
FNAIT can lead to severe thrombocytopenia. A very low platelet count means the blood doesn’t clot and this can cause uncontrolled bleeding and hemorrhage in the brain and other organs, with potentially life-threatening consequences.
However, FNAIT-affected infants can also be asymptomatic or present with only mild symptoms. These symptoms may include petechiae, purpura (purple spots or patches on the skin), bleeding and easy bruising. More serious symptoms include cephalohematoma (a bulge on the scalp due to bleeding under the skin), blood in the stool or vomit, intracranial hemorrhage and a low platelet count.
Learn more about FNAIT signs and symptoms
The importance of recognizing petechiae
A key symptom of FNAIT, petechiae can appear within minutes or hours of birth and consist of a rash of tiny, pinpoint red, purple or sometimes brown dots. They are caused by pressure on the skin during delivery, with tiny blood vessels bleeding under the skin as a result of a low platelet count. The dots don’t fade or turn white when the skin is pressed.
Petechiae can spread across different parts of the baby’s body including, face, torso, arms and legs. They may also be found inside the mouth or in the white parts of the eyes.
Recognizing petechiae and querying its appearance is an important part of identifying FNAIT in newborns. Platelet levels will then be tested, and other symptoms assessed.
Treating petechiae in the FNAIT newborn
When FNAIT is suspected in newborns, urgent blood platelet transfusions are given to increase platelet levels and stop bleeding to avoid severe complications before a diagnosis of FNAIT is confirmed. It is important to confirm FNAIT to guide medical care of subsequent pregnancies but the decision to treat thrombocytopenia is based on symptoms.
Platelet transfusions take around 30 minutes, and platelet levels will be tested again 1 hour after the transfusion, to confirm that they are starting to rise. The newborn’s platelet counts and symptoms will be carefully monitored until they return to normal.
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