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Development of the human coagulation system in the healthy premature infant
1Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ontario, Canada.
Insights
The human coagulation system in premature infants develops rapidly, reaching near-adult levels by six months. This study tracked key clotting factors and inhibitors in healthy premature infants, revealing accelerated maturation compared to full-term infants.
Area of Science:
- Pediatrics
- Hematology
- Neonatology
Background:
- The coagulation system's development in premature infants is not fully understood.
- Assessing coagulation parameters is crucial for managing bleeding risks in neonates.
Purpose of the Study:
- To determine the postnatal development of the human coagulation system in healthy premature infants (30-36 weeks gestational age).
- To establish reference ranges for coagulation components in premature infants.
- To compare the maturation of the coagulation system in premature infants with full-term infants and adults.
Main Methods:
- Blood samples were collected from 137 premature infants on days 1, 5, 30, 90, and 180 postnatally.
- Prothrombin time, activated partial thromboplastin time, thrombin clotting time, plasminogen, 13 factor assays, and 8 inhibitor assays were performed.
- Biologic and immunologic assays were utilized to analyze coagulation components.
Main Results:
- Minimal effect of gestational age was observed for antithrombin III (AT-III), protein C (PC), and factors II and X.
- Postnatal maturation of most coagulation components was accelerated in premature infants compared to full-term infants.
- By 6 months of age, premature infants achieved near-adult levels for most coagulation factors and inhibitors.
Conclusions:
- Premature infants exhibit accelerated postnatal development of their coagulation system.
- Established reference ranges are essential for monitoring coagulation in this population.
- Findings provide valuable insights into the hemostatic system's maturation in neonates.
Abstract:
This study was designed to determine the postnatal development of the human coagulation system in the healthy premature infant. Consecutive mothers of healthy premature infants born at either St Joseph's Hospital or McMaster University Medical Centre in Hamilton were asked for consent. One hundred thirty-seven premature infants (30 to 36 weeks of gestational age) entered the study. The premature infants did not have any major health problems and did not require ventilation or supplemental oxygen. Demographic information and a 20-mL blood sample were obtained in the postnatal period on days 1, 5, 30, 90, and 180. Between 40 and 96 premature infants were studied on each day for each of the following tests: prothrombin time, activated partial thromboplastin time, thrombin clotting time, plasminogen; 13 factor assays [fibrinogen, II, V, VII, VIII, IX, X, XI, XII, XIII, high-mol-wt kininogen (HMWK), prekallikrein (PK), von Willebrand factor (vWF)] and eight inhibitors [antithrombin III (AT-III), heparin cofactor II, alpha 2-antiplasmin, alpha 2-macroglobulin, alpha 1-antitrypsin, C1 esterase inhibitor, protein C (PC), and protein S (PS)]. A combination of biologic and immunologic assays were used. Between 30 to 36 weeks there was a minimal effect of gestational age for levels of AT-III, PC, and factors II and X only; therefore, the entire data set was used to generate reference ranges for these components of the coagulation system for premature infants. Next, the results for the premature infants were compared with those of a previously published study in 118 fullterm infants and with those for adults. An effect of gestational age was shown for plasminogen, fibrinogen, factors II, V, VIII, IX, XI, XII, HMWK, and all eight inhibitors. In general, the postnatal maturation towards adult levels was accelerated in premature infants as compared with the fullterm infants. By 6 months of age, most components of the coagulation system in premature infants had achieved near adult values.