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Coagulation studies in extremely premature infants.

D R Barnard, M A Simmons, W E Hathaway

    Pediatric Research
    |December 1, 1979
    PubMed
    Summary

    Coagulation factors in extremely premature infants (EPT) show developmental changes with gestational age, differing from full-term infants. Severely ill EPT infants exhibit coagulation alterations linked to intravascular coagulation and potential factor VIII dysfunction.

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    Area of Science:

    • Neonatal physiology
    • Hemostasis and thrombosis
    • Developmental biology

    Background:

    • Infant coagulation systems differ significantly from adults.
    • Premature infants, especially extremely premature (EPT), present unique hemostatic challenges.
    • Understanding these differences is crucial for managing bleeding and clotting risks.

    Purpose of the Study:

    • To investigate the developmental evolution of coagulation in thriving extremely premature (EPT) infants.
    • To compare coagulation profiles of EPT infants with normal full-term (FT) infants.
    • To identify specific coagulation factor alterations in EPT infants, including those who are severely ill.

    Main Methods:

    • Comparative analysis of coagulation studies in EPT and FT infants.
    • Assessment of prothrombin time, partial thromboplastin time, thrombin time, fibrinogen, platelets, and fibrin degradation products.
    • Evaluation of anti-thrombin III, factors II, VII, VII-X complex, XI, XII, high molecular weight kininogen, prekallikrein, factor V, and factor VIII activity and antigen levels.

    Main Results:

    • Coagulation times shortened with increasing gestational age in EPT infants.
    • Fibrinogen and platelet levels were comparable to term infants and adults.
    • Marked decreases in contact factors and factor V were observed in EPT infants.
    • Gestational dependency of anti-thrombin III and factor VIII activity was confirmed, with an elevated factor VIII antigen to activity ratio in EPT infants.
    • Severely ill EPT infants showed changes in factors I, V, and VIII, consistent with intravascular coagulation.

    Conclusions:

    • Coagulation in EPT infants demonstrates significant gestational age dependency.
    • A dysfunctional or fetal factor VIII may be produced in thriving EPT infants, indicated by the high antigen to activity ratio.
    • Severely ill EPT infants exhibit pathological proteolysis or increased endothelial release of factor VIII antigen, further elevating this ratio.

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