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Antithrombin-III substitution in preterm infants--effect on intracranial hemorrhage and coagulation parameters
R Brangenberg1, M Bodensohn, U Bürger
1Department of Pediatrics, Kreiskrankenhaus Traunstein, Academic Hospital of the University of Munich, Germany.
Insights
Early antithrombin III (AT-III) substitution in preterm infants improved coagulation and reduced intracranial hemorrhage (IVH) incidence. This intervention may be crucial for managing bleeding risks in premature neonates.
Area of Science:
- Neonatal Medicine
- Hematology
- Pediatric Critical Care
Background:
- Preterm infants exhibit reduced antithrombin III (AT-III) activity, increasing risks of mortality and intracranial hemorrhage (IVH).
- Low AT-III levels are linked to sepsis and respiratory distress syndrome in neonates.
- Early identification and management of coagulation abnormalities are critical in preterm infants.
Purpose of the Study:
- To evaluate the impact of early AT-III substitution on coagulation parameters in preterm infants.
- To assess the effect of AT-III concentrate on the incidence and severity of intraventricular hemorrhage (IVH).
- To determine optimal AT-III substitution strategies for neonatal care.
Main Methods:
- A study involving 103 preterm infants (25-32 weeks gestational age) receiving AT-III concentrate.
- AT-III activity, Quick's prothrombin time (PT), partial thromboplastin time (PTT), and platelet count were monitored.
- Infants received initial AT-III dosage and subsequent doses if activity fell below 50%.
Main Results:
- Pre-substitution AT-III activity was significantly lower (mean 40%) than in term infants.
- Quick's PT and PTT normalized to term values within the first week post-substitution.
- The incidence of IVH was notably lower (13%) compared to existing epidemiological data, with no cases of grade IV IVH.
Conclusions:
- Early AT-III substitution in preterm infants effectively improves coagulation parameters.
- AT-III concentrate administration appears to reduce the incidence and progression of intraventricular hemorrhage.
- This therapeutic approach holds promise for improving outcomes in high-risk preterm neonates.
Abstract:
In preterm infants the activity of antithrombin III (AT-III), the main inhibitor of thrombin, is reduced depending on gestational age and complications such as sepsis or respiratory distress syndrome. Babies with low levels of AT-III have been shown to have a higher mortality and an increased incidence of intracranial hemorrhage. In our study we tried to show the effect of early AT-III substitution on coagulation parameters and the incidence of intraventricular hemorrhage (IVH). One hundred three preterm infants at a gestational age of 25-32 weeks (mean 28.9 weeks; birth weight 600-2,170 g, mean 1,285 g) received AT-III concentrate at a single dosage of 50-200 IU/kg on the day of birth and subsequently only in case of a new decrease below an AT-III activity of 50%. We measured AT-III activity, Quick's prothrombin time (PT), partial thromboplastin time (PTT) and platelet count on the day of birth, and after 1 and 5-9 days in 25 patients. AT-III activity before substitution was lower than described for term infants (20-72%, mean 40%). Within the first week of life Quick's PT and PTT reached almost term values. No significant differences of the platelet count were found within the first week of life. The incidence of IVH was lower than in current epidemiologic studies: in only 13% of the study patients. Six percent of the infants had IVH grade I, 3% grade II, 4% grade III and none grade IV. Therefore, in preterm infants AT-III substitution may reduce the incidence and progression of intracranial hemorrhage.