Severe Persistent Neonatal Immune Thrombocytopenia Despite Optimized Maternal Chronic Immune Thrombocytopenia (ITP) Management

Immune thrombocytopenia (ITP) is the most common cause of thrombocytopenia in pregnancy, with maternal autoantibodies crossing the placenta and predisposing neonates to severe thrombocytopenia. Neonatal immune thrombocytopenia (NIT) can result in significant morbidity, including intracranial hemorrhage. We report a term neonate born to a mother with chronic severe ITP. Despite antenatal therapy with corticosteroids, intravenous immunoglobulin (IVIG), and elective cesarean delivery at a safe maternal platelet threshold, the neonate presented with severe thrombocytopenia requiring multiple platelet transfusions, repeated courses of IVIG, and adjunctive steroids. The infant’s course was prolonged, requiring 29 days of hospitalization, though ultimately discharged with recovery of platelet counts. This case underscores the persistent risk of NIT despite optimal maternal management, highlights maternal predictors such as prior affected offspring and history of splenectomy, and illustrates the therapeutic dilemmas in neonatal care. Early recognition and coordinated multidisciplinary management remain critical to reducing morbidity in mother-infant dyads affected by ITP.