Does risk-based coagulation screening predict intraventricular haemorrhage in extreme premature infants?

Intraventricular haemorrhage (IVH) continues to be a significant contributor to neonatal morbidity and mortality, especially in the extremely premature population (<26 weeks). The aims of the study were to test the hypothesis that risk-based coagulopathy screening could identify infants at risk of severe IVH/mortality, and whether preterm infants born at less than 26 weeks of gestation who received early (within first 48 h) fresh frozen plasma (FFP) had a lower incidence of IVH than those who did not.

Chart review of preterm infants born less than 26-week gestation was conducted. The study compared two cohorts of infants who either had 'early' risk-based coagulopathy screening (within first 48 h, n = 47) or 'late' screening (n = 55).

Baseline and clinical characteristics of the two cohorts were similar. 'Early' coagulopathy screening predicted infants at risk of severe IVH [relative risk (RR) 2.59, 95% confidence interval (CI) 1.18-5.67, P < 0.01] but not mortality (RR 1.2, 95% CI 0.79-1.94). FFP was administered significantly more in the 'early' screened cohort (P < 0.001); however, the incidence of IVH was similar in those who received early FFP administration than those who did not.

'Early' risk-based coagulopathy screening may identify preterm infants at risk of severe IVH; however, the study failed to show any benefit of early treatment of a coagulopathy with FFP in a small but high-risk population.