Petechial Rash in Neonates: Management Algorithm

Abstract

Petechial rash in neonatal period commonly results from thrombocytopenia. Disorders of coagulation and those affecting vascular integrity may cause purpuric rash. Common causes of neonatal thrombocytopenia include early onset thrombocytopenia (onset < 72 hours) due to placental insufficiency, perinatal asphyxia, perinatal infections and DIC. Atloimmune thrombocytopenia is rare but potentially serious disorder. Late onset thrombocytopenia (onset > 72 hours) almost always results from sepsis and NEC. Intrauterine infections and perinatally acquired dengue and chikungunaya infections also need to be considered in appropriate clinical settings. Infantile acute hemorrhagic edema, meningococcal rash and blue berry muffin baby are causes of purpuric rash without thrombocytopenia and may require exclusion. In addition to these, this review also includes uncommon causes of petechial/ purpuric rash in neonatal period. Clinical approach to diagnosis and management are discussed.