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Coagulation indices in very preterm infants from cord blood and postnatal samples

E Neary1, N McCallion1,2, B Kevane3,4

  • 1Department of Neonatology, Rotunda Hospital, Dublin, Ireland.

Journal of Thrombosis and Haemostasis : JTH
|September 4, 2015
PubMed

Insights

Standard coagulation tests in very premature infants show prolonged clotting times but normal thrombin generation compared to term infants. These findings help establish reference ranges for preterm neonates.

Area of Science:

  • Neonatal Medicine
  • Hematology
  • Pediatric Coagulation

Background:

  • Very premature infants face a high risk of bleeding complications.
  • Limited data exists on coagulation test ranges for this vulnerable population.

Purpose of the Study:

  • To establish reference ranges for standard plasma coagulation tests and thrombin generation in very premature infants.
  • To compare these coagulation parameters between preterm and term neonates.
  • To investigate the association between coagulation indices and intraventricular hemorrhage (IVH).

Main Methods:

  • Collected cord and peripheral blood from neonates < 30 weeks gestational age (GA) at multiple time points.
  • Measured prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, and coagulation factor levels.
  • Characterized tissue factor-stimulated thrombin generation and compared with term infant controls.

Main Results:

  • Determined median day 1 PT, APTT, and fibrinogen levels for very preterm infants.
  • Observed reduced levels of coagulation factors II, VII, IX, X, protein C, protein S, and antithrombin in preterm infants.
  • Found no significant difference in endogenous thrombin potential between preterm and term infants.
  • Demonstrated no association between Day 1 APTT/PT and IVH.

Conclusions:

  • Established typical ranges for standard coagulation tests in the largest study of very preterm infants to date.
  • Despite prolonged clotting times, thrombin generation capacity is similar in very preterm and term infants.
  • Findings provide crucial reference data for managing coagulation in extremely preterm neonates.
Abstract

Keywords:
blood coagulationblood coagulation factorshemorrhagehemostasisinfant, premature

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