Very premature infants born to mothers with early-onset preeclampsia (PE) were more likely to need platelet transfusions—raising the risk of complications—even in the absence of fetal and neonatal alloimmune thrombocytopenia (FNAIT), according to results from a study published recently in the Journal of Pediatric Hematology/Oncology.
This new study found that although hematological parameters on the first day of life did not significantly differ overall, babies exposed to PE required platelet support far more often than those who were not.
“Our study did not confirm the existence of changes in hematological parameters and indices in the blood count collected on D1 [day 1] in very premature infants born to mothers with PE,” explained the authors of this study. They continued, “We present a novel finding, which is the heightened requirement for platelet transfusions in preterm infants born to mothers with PE, a fact that underscores the elevated risk of neonatal morbidity, mortality, and neurodevelopmental impairment at 2 years of age.”
Conducted at a level III neonatal intensive care unit between 2008 and 2023, this study retrospectively examined 206 preterm infants born before 30 weeks of gestation. Among them, 39 (18.93%) were exposed to PE. While the initial blood counts taken on day one showed some differences—such as higher mean corpuscular volume and erythroblasts, and lower white blood cells and platelets—these changes did not prove significant when analyzed alongside other clinical factors.
Read more about FNAIT causes and risk factors
What did stand out was the need for platelet transfusions: 51.8% of infants exposed to PE received them, compared with just 20.36% of those not exposed. This difference was statistically significant (P < 0.0001), suggesting a meaningful link between maternal PE and this form of neonatal intervention. Logistic regression confirmed this association even after adjusting for gestational age, birth weight, delivery method, and other maternal conditions, with an odds ratio of 2.835 (95% CI: 1.560–8.084, P = 0.04).
No cases of FNAIT were found in this group, confirming that the increased platelet needs were not caused by this immune-related disease. Other complications such as fetal growth restriction, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, and small-for-gestational-age status were more frequent in the PE group, further emphasizing the complexity and severity of these pregnancies.
While these results did not reveal significant hematological abnormalities directly linked to PE exposure, they underscore the importance of monitoring and early intervention. For families and care teams, understanding that these infants are more likely to need platelet transfusions—even without FNAIT—can support better planning and faster responses during a critical window of neonatal care.
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