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'Normal' haemostasis parameters: a study in a well-defined inborn population of preterm infants
Insights
Coagulation factors in preterm infants mature with age, showing increased vitamin K-dependent and independent factors. Platelet counts remain stable, but megathrombocyte index rises in very premature infants.
Area of Science:
- Neonatal Medicine
- Hematology
- Pediatric Coagulation
Background:
- Neonatal hemostasis differs significantly from adults.
- Preterm infants present unique challenges in coagulation assessment.
Purpose of the Study:
- To investigate the changes in coagulation parameters in preterm neonates.
- To correlate hemostasis markers with postnatal and gestational age.
Main Methods:
- Coagulation studies performed on cord blood and arterial blood at 48 hours.
- Analysis included vitamin K-dependent and independent factors, APTT, and platelet parameters.
- Eighty preterm infants meeting inclusion criteria were studied.
Main Results:
- Coagulation factors and fibrinogen increased with postnatal and gestational age.
- Activated Partial Thromboplastin Time (APTT) shortened with increasing age.
- Platelet parameters were largely unchanged, except for an increased megathrombocyte index in infants <29 weeks gestation.
Conclusions:
- Neonatal coagulation system undergoes significant maturation post-birth.
- Many coagulation results in preterm infants fall outside adult normal ranges.
- Interpretation of neonatal hemostasis requires age-specific reference values.
Abstract:
Coagulation studies were performed in a well-defined inborn population of preterm neonates in cord blood and arterial blood obtained at age 48 h. Eighty infants fulfilled all the inclusion criteria. Our results show an increase in the hepatic vitamin K1 dependent and independent factors with postnatal age. The APTT became shorter, the factor II-VII-X, alpha 2-antiplasmin, plasminogen activities and fibrinogen level rose with increasing postnatal age. We found no change in the platelet parameters measured with postnatal age except that the megathrombocyte index was increased at age 48 h in infants less than 29 weeks gestation. There was little change with gestational age of any factors except the vitamin K1 dependent factors. Factor II-VII-X activity rose and the APTT became shorter with increasing gestational age. Many of the haemostasis results did not fall within the normal adult range. We discuss the significance of 'abnormal' and 'normal' results in preterm infants.