A baby born of IVF pregnancy, delivered by emergency LSCS due to high blood pressure in the mother, was well after the initial 12 hours of being born. However, at 12 hours of life, the baby started having reddish blue spots (small bleeding) on the soles and back and so it was shifted to the NICU. It was given antibiotics after the blood tests were done, considering that infection is the commonest cause of this problem. Just before the reports came in, the baby experienced weakness in the right hand, leg and difficulty in opening right eye suggestive of intracranial bleed.
Blood tests reports, when received, showed severely decreased platelets in the hemoglobin of the baby. They showed only 5000 platelets whereas the normal count is above 1.5 lakh. The baby was further evaluated after giving emergency platelet and blood transfusion to prevent further bleeding. CT brain was done which confirmed significant bleeding causing compression of brain, shifting from right to left side. The baby started having difficulty in breathing too.
The parents were explained about the condition and the neurosurgeons Dr. Kishor and Dr. Shashank were also involved for further care. The risk in surgery was very high considering the 1.9 kg 36 weeks preterm baby. However, just observing the baby would have caused respiratory arrest due to compression of the breathing center of the brain. After counseling the parents, we decided to do the surgical intervention. In OT, almost 80 ml blood clot was removed (this Baby had a normal blood volume of almost 160-180 ml) so 50% of blood was removed.
The baby was given breathing support, blood transfusion, platelet transfusion, and thus recovered well. The weakness in hand, legs and eyes had almost recovered completely. We did further tests for the baby and they showed that the mother’s platelets were acting against the baby's platelets, which was the cause of this problem. This condition is called as Neonatal Alloimmune Thrombocytopenia (NAITS) that leads to severe decrease in the platelet count and life threatening bleeding in the brain. The baby who was so critical initially was successfully treated upon and was discharged on breast feeding without any immediate neurological weakness.--
Dr Omprakash Jamadar,
FELLOW NEONATOLOGY LONDON,UK.