Multisystem hemorrhage in a very preterm infant born to a mother with immune thrombocytopenia: a case report and literature review.

Background: Maternal immune thrombocytopenia (ITP) may cause neonatal ITP (NITP) via transplacental IgG. Evidence in very-preterm infants remains limited. Case presentation: A male infant born at 28 + 3 weeks (1,100 g) to a mother with long-standing ITP developed severe early-onset thrombocytopenia (nadir 26 × 10⁹/L) and multisystem hemorrhage (pulmonary, gastrointestinal, and Papile grade III intraventricular hemorrhage). Despite three courses of intravenous immunoglobulin (IVIG, 1 g/kg each) and multiple platelet (PLT) transfusions, early hematologic responses were suboptimal; PLT counts began to rise on day-of-life 14 and normalized by day 19. Bone-marrow examination showed impaired megakaryopoiesis, and no definitive pathogenic genetic variant was identified. Discussion: The presentation suggests a multifactorial pathogenesis in very-preterm NITP-maternal antibody-mediated PLT destruction, gestational-age-related limits in PLT production, and potential genetics-mediated immune dysregulation. Variable IVIG exposure/effect in preterm infants may relate to developmental FcRn biology. Mechanism-aligned care may include careful IVIG dosing/timing, judicious PLT transfusion with immunologically guided selection, and targeted immune-genetic evaluation in IVIG-suboptimal responders. Conclusion: The manuscript reports a case of a very preterm male infant born to a mother with ITP, who presented with severe thrombocytopenia and multisystem hemorrhage that was difficult to manage. This case highlights the necessity of an active and comprehensive management strategy for such infants to provide individualized interventions for the immune thrombocytopenia while concurrently addressing general problems associated with prematurity.