Neonatal coagulopathy in preterm, small-for-gestational-age infants

Our aim was to determine if antenatal hypoxia was associated with liver dysfunction and coagulation abnormalities in small-for-gestational-age (SGA) infants. Sixteen SGA infants, median gestational age 30 (range 26-32) weeks, who consecutively had had umbilical artery Doppler studies in the week before delivery, were compared to appropriate-for-gestational-age (AGA) controls, who were each matched to an SGA infant for gestational age. The median international normalised ratio (INR) was significantly higher (1.9 vs. 1.3, p < 0.001) and the neutrophil (p = 0.003) and platelet counts (p < 0.001), alkaline phosphatase (p < 0.001) and albumin (p < 0.02) levels significantly lower in the SGA compared to the AGA group. The umbilical artery pulsatility index (PI) was elevated, indicating antenatal hypoxia, in all but 1 of the SGA infants. Multiple linear regression analysis demonstrated that the INR was significantly related to the umbilical artery PI independent of the other variables (p = 0.0002, R(2) = 0.71). These results suggest that the coagulopathy seen in preterm SGA infants might at least be partially explained by antenatal hypoxia affecting the liver and hence vitamin K-dependent coagulation.