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Elevated International Normalized Ratio (INR) is Associated With an Increased Risk of Intraventricular Hemorrhage in

Alessandra Glover Williams1, David Odd1,2, Sarah Bates1

  • 1Southmead Neonatal Intensive Care Unit.

Journal of Pediatric Hematology/Oncology
|May 29, 2019
PubMed

Insights

Elevated international normalized ratio (INR) in preterm infants within 48 hours of birth is linked to a higher risk of severe intraventricular hemorrhage (IVH). Early INR monitoring can help identify at-risk infants and guide preventative strategies.

Area of Science:

  • Neonatal Medicine
  • Pediatric Neurology
  • Coagulation Disorders

Background:

  • The international normalized ratio (INR) reflects vitamin K-dependent coagulation pathways.
  • Intraventricular hemorrhage (IVH) is a significant concern in extremely preterm infants.
  • Early identification of IVH risk factors is crucial for timely intervention.

Purpose of the Study:

  • To investigate the association between early-life INR measurements and the development of IVH.
  • To determine if INR can serve as a predictive marker for severe IVH in extremely preterm neonates.

Main Methods:

  • Retrospective, observational cohort study including infants born before 28 weeks gestation.
  • INR levels were assessed within the first 48 hours of life.
  • The primary outcome was the severity of IVH, assessed by cranial ultrasound at 7 days postnatal age.

Main Results:

  • An elevated INR was significantly associated with an increased risk of severe IVH (OR 6.50, P=0.008).
  • This association was particularly strong in infants who did not receive blood products (OR 64.60, P=0.035).
  • Among infants receiving blood products, the association between INR and severe IVH was not statistically significant.

Conclusions:

  • Elevated INR in the first 48 hours of life may identify preterm infants at higher risk for severe IVH.
  • Early INR monitoring could inform strategies to prevent or limit IVH development and progression.
  • Further research may explore the clinical utility of INR in managing coagulopathy in preterm neonates.
Abstract

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