Incidence, Risk Factors, and Outcomes of Thrombocytopenia among Neonates Admitted with Neonatal Sepsis at Lira Regional Referral Hospital, Northern Uganda

Background: Neonatal sepsis remains a major cause of morbidity and mortality globally, particularly in low- and middle-income countries. Thrombocytopenia is a frequent hematological abnormality associated with sepsis and is linked to adverse outcomes. However, data on its incidence, determinants, and outcomes in Ugandan neonates are limited. Methods: A hospital-based prospective study was conducted at Lira Regional Referral Hospital from January to June 2024. A total of 424 neonates admitted with neonatal sepsis were consecutively enrolled. Clinical and demographic data were collected, and complete blood counts were performed to assess platelet levels. Thrombocytopenia was defined as a platelet count < 150 × 10³/µL. Logistic regression was used to determine independent risk factors, and outcomes were evaluated in terms of mortality and duration of hospital stay. Results: Of the 424 neonates studied, 125 (29.5%) developed thrombocytopenia. The independent risk factors associated with thrombocytopenia included prolonged labor (> 24 hours), low birth weight, neonatal dehydration, and necrotizing enterocolitis. Thrombocytopenia was significantly associated with adverse outcomes. Mortality among thrombocytopenic neonates was 16.0% compared to 3.3% in non-thrombocytopenic neonates. Additionally, prolonged hospital stay (> 7 days) occurred in 66.7% of thrombocytopenic neonates compared to 17.6% of those without thrombocytopenia. Conclusion: Thrombocytopenia is a common complication among neonates with sepsis at Lira Regional Referral Hospital, occurring in nearly one-third of cases. It is strongly associated with poor outcomes, including higher mortality and prolonged hospitalization. Early identification and routine platelet monitoring in neonates with sepsis are critical for timely intervention. Targeted attention should be given to high-risk groups such as low-birth-weight infants, those with prolonged labor, dehydration, or necrotizing enterocolitis. Incorporating thrombocytopenia monitoring into neonatal care protocols could improve survival and reduce morbidity in resource-limited settings.