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Fresh-frozen plasma as a source of exogenous insulin-like growth factor-I in the extremely preterm infant
Ingrid Hansen-Pupp1, Eva Engström, Aimon Niklasson
1Division of Pediatrics, Department of Clinical Sciences Lund, Lund University Hospital, 221 85 Lund, Sweden. ingrid.pupp@skane.se
Insights
Fresh-frozen plasma (FFP) transfusions significantly increase insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) levels in extremely preterm infants. This intervention helps restore crucial proteins important for neurodevelopment and blood vessel growth.
Area of Science:
- Neonatology
- Pediatric Endocrinology
- Transfusion Medicine
Background:
- Preterm birth is associated with reduced levels of IGF-I and IGFBP-3, critical for neurogenesis and angiogenesis.
- Maintaining adequate IGF-I and IGFBP-3 levels is vital for the development of extremely preterm infants.
Purpose of the Study:
- To investigate the impact of fresh-frozen plasma (FFP) transfusions on circulatory IGF-I and IGFBP-3 levels in extremely preterm infants.
- To assess the efficacy of FFP administration in normalizing key growth factor levels.
Main Methods:
- A prospective cohort study involving 20 extremely preterm infants requiring FFP transfusion.
- Blood samples were collected before and at multiple time points after FFP transfusion to measure IGF-I and IGFBP-3 concentrations.
Main Results:
- FFP transfusion led to a significant increase in IGF-I (133%) and IGFBP-3 (61%) levels immediately post-transfusion.
- Elevated levels of both IGF-I and IGFBP-3 were sustained for up to 12 hours after transfusion.
- The estimated half-life of administered IGF-I was approximately 3.4 hours per kilogram of infant weight.
Conclusions:
- FFP transfusion is an effective method for increasing IGF-I and IGFBP-3 levels in extremely preterm infants.
- This intervention may support the neurodevelopmental and angiogenic processes in this vulnerable population.
Context:
Preterm birth is followed by a decrease in circulatory levels of IGF-I and IGF binding protein (IGFBP)-3, proteins with important neurogenic and angiogenic properties.
Objective:
Our objective was to evaluate the effects of iv administration of fresh-frozen plasma (FFP) from adult donors on circulatory levels of IGF-I and IGFBP-3 in extremely preterm infants.
Design, Setting, And Patients:
A prospective cohort study was performed in 20 extremely preterm infants [mean (SD) gestational age 25.3 (1.3) wk] with clinical requirement of FFP during the first postnatal week. Sampling was performed before initiation of transfusion, directly after, and at 6, 12, 24, and 48 h after completed FFP transfusion.
Main Outcome Measures:
Concentrations of IGF-I and IGFBP-3 before and after transfusion of FFP were determined.
Results:
FFP with a mean (SD) volume of 11 ml/kg (3.1) was administered at a median postnatal age of 2 d (range 1-7). Mean (SD) IGF-I and IGFBP-3 concentrations in administered FFP were 130 (39) and 2840 microg/liter (615), respectively. Immediately after FFP transfusion, mean (SD) concentrations of IGF-I increased by 133% from 11 (6.4) to 25 microg/liter (9.3) (P < 0.001) and IGFBP-3 by 61% from 815 (451) to 1311 microg/liter (508) (P < 0.001). Concentrations of IGF-I and IGFBP-3 remained higher at 6 (P < 0.001, P = 0.009) and 12 h (P = 0.017, P = 0.018), respectively, as compared with concentrations before FFP transfusion. Typical half-life of administrated IGF-I was 3.4 h for a 1-kg infant.
Conclusion:
Transfusion of FFP to extremely preterm infants during the first postnatal week elevates levels of IGF-I and IGFBP-3.
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