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COAGULATION ABNORMALITIES IN THE FIRST 2 DAYS OF LIFE AND SEVERE INTRAVENTRICULAR HAEMORRHAGE IN EXTREMELY LOW BIRTH WEIGHT INFANTS
  1. A J Piotrowski1,
  2. I Dąbrowska-Wójciak1
  1. 1Department of Anaesthesia and Intensive Care, Paediatric University Hospital, Medical University of Lodz, Lodz, Poland

Abstract

Background Only few studies assessing the risk for intraventricular hemorrhage (IVH) in neonates have reported measurements of coagulation factors. Prematurity, lack of antenatal steroid therapy and postnatal transfer to the intensive care unit (ICU) increase the prevalence of IVH; controversy remains about the role of the coagulation system.

Objectives We designed a study to evaluate selected coagulation and fibrinolysis system factors in extremely low birth weight infants (ELBW) admitted to the referral ICU, to find the correlation between their levels in the initial 48 hours of life and development of IVH.

Patients and methods Coagulation status of 38 out of 41 planned ELBW infants was assessed. Severity of IVH detected by ultrasound was graded according to the scale of Papile. Group A comprised of newborns with III or IV grade IVH, and group B those with no or low grade IVH.

Results IVH was present in 82% (n = 31) of neonates. Those with grade III/IV IVH had significantly lower plasma Factor VII level on day 1 of life and this could differentiate between group A and B, with sensitivity of 100% and specificity 41% for a cut-off value of less than 7%. In group A there was also a significantly prolonged prothrombin and activated partial thromboplastin time on day 2. A significant decline of platelet count was observed.

Conclusions High-grade IVH coincides with severe derangement of coagulation in ELBW infants, the level of factor VII being the most sensitive.

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