When a newborn is suspected of fetal and neonatal alloimmune thrombocytopenia (FNAIT), their care will typically be managed in the neonatal intensive care unit (NICU).
Before a diagnosis of FNAIT is confirmed, urgent treatment decisions may be made based on symptoms such as bruising, pinprick bleeding under the skin, low blood platelet counts and unexplained bleeding from umbilical cord sites or needle punctures. The NICU team will monitor bleeding risks using a combination of imaging, blood tests and close monitoring.
NICU multidisciplinary care
The NICU team is composed of a range of specialists who collaborate to ensure the best outcomes for newborns suspected of having FNAIT. Diagnosis can be confirmed during pregnancy, but often it is only suspected following delivery when symptoms are identified. When it is suspected or diagnosed, the newborn is transferred to the NICU, where specialized tests and constant observation are key to detecting bleeding.
In the NICU, the team of physicians may include neonatologists, maternal-fetal specialists, neurologists and neonatal nurses.
Detecting bleeding in newborns with FNAIT
In FNAIT, low blood platelet counts cause the blood to lose its capacity to clot. This can lead to uncontrolled bleeding and hemorrhage. If diagnostic tests show a low blood platelet count, platelet transfusions may be prescribed to prevent severe outcomes.
Doctors may monitor bleeding risks in newborns by:
Carefully monitoring newborns to assess the evolution of symptoms of petechiae, purpura and bruising.
Observing newborn behavior such as poor feeding, lethargy, irritability and seizures.
Watching for any changes in blood pressure, breathing or heart rate that may suggest internal bleeding.
Testing blood regularly to track blood platelet counts and monitor whether they are rising or falling.
Ordering a cranial ultrasound to check for intracranial hemorrhage.
Ordering an ultrasound of the stomach to check for gastrointestinal bleeding.
If bleeding is detected, urgent treatment is required to boost blood platelet levels and stop the bleeding. The most common treatment is blood platelet transfusions without the specific platelet antigen that caused the mother-baby HPA incompatibility. In some cases, intravenous immunoglobulin (IVIG) is also used to block maternal antibodies.
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