Dynamic prediction of bleeding risk in thrombocytopenic preterm neonates

Over 75% of severely thrombocytopenic neonates receive platelet transfusions, though little evidence supports this practice, and only 10% develop major bleeding. In a recent randomized trial, platelet transfusions given at a threshold of 50x109 /L compared to a threshold of 25x109 /L were associated with increased risk of major bleeding or mortality. These results emphasize the need for improved and individualized neonatal platelet transfusion guidelines, which require accurate prediction of bleeding risk. Therefore, the objective of this study was to develop a dynamic prediction model for major bleeding in thrombocytopenic preterm neonates. This model allows for calculation of bleeding risk at any time-point during the first week after onset of severe thrombocytopenia. In this multicenter cohort study, we included neonates with a gestational age <34 weeks, admitted to a neonatal intensive care unit, who developed severe thrombocytopenia (platelet count <50x109 /L). The study endpoint was major bleeding. We obtained predictions of bleeding risk using a proportional baselines landmark supermodel. Of 640 included neonates, 71 (11%) developed major bleeding. We included the variables gestational age, postnatal age, intra-uterine growth restriction, necrotizing enterocolitis, sepsis, platelet count and mechanical ventilation in the model. The median cross-validated c-index was 0.74 (IQR 0.69-0.82). This is a promising dynamic prediction model for bleeding in this population that should be explored further in clinical studies as a potential clinical decision support tool. The study was registered at www.clinicaltrials.gov (NCT03110887).

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