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Published on: August 25, 2022
Heparin and the risk of intraventricular hemorrhage in premature infants
G Y Chang1, F L Lueder, D M DiMichele
1Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois, USA.
Insights
Low-dose heparin in umbilical catheter infusates does not increase the risk of intraventricular hemorrhage in premature infants. Coagulation profiles remained largely unaffected, indicating safety for neonatal care.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Pharmacology
Background:
- Intraventricular hemorrhage (IVH) is a significant concern in premature infants.
- Umbilical catheters are frequently used in neonatal intensive care, posing potential risks.
- The use of heparin in infusates is debated for its safety and efficacy in neonates.
Purpose of the Study:
- To evaluate the safety of low-dose heparin in umbilical catheter infusates.
- To determine if heparin increases the risk of intraventricular hemorrhage (IVH) in premature infants.
- To assess the impact of heparin on neonatal coagulation profiles.
Main Methods:
- A randomized, blinded trial involving 113 infants born before 31 weeks' gestation.
- Infants received either heparin (1 unit/mL) or no heparin in their umbilical catheter infusate.
- Coagulation parameters (PT, aPTT, fibrinogen, AT-III) and cranial ultrasonography were monitored.
Main Results:
- No significant difference in the incidence of intraventricular hemorrhage (IVH) between heparin and no-heparin groups (35.8% vs. 31.5%).
- No difference in severe IVH (grades III/IV) or major coagulation parameters (PT, aPTT, fibrinogen).
- Heparin use was associated with lower antithrombin III activity; antenatal indomethacin increased IVH risk.
Conclusions:
- Low-dose heparin in umbilical catheter infusates is safe and does not elevate IVH risk in premature infants.
- Heparin does not significantly alter key coagulation parameters in this population.
- Findings support the judicious use of heparin in neonatal umbilical catheter care.
Objective:
This study was carried out to determine whether the routine use of low-dose heparin in umbilical catheter infusates increases the risk of intraventricular hemorrhage or alters the coagulation profile in premature infants.
Methods:
In a randomized, blinded trial, 113 infants born at less than 31 weeks' gestation were assigned to receive, in their umbilical catheter infusate, either 1 unit of heparin per milliliter (n = 55) or no heparin (n = 58). Prothrombin time, activated partial thromboplastin time, fibrinogen concentration, and antithrombin III activity levels were determined at the start and the completion of the study. Cranial ultrasonography was performed during the first week of life.
Results:
There was no difference in the incidence of intraventricular hemorrhage between the heparin and no heparin groups, 35.8% and 31.5%, respectively (p = 0.6). Similarly, no difference was detected in the incidence of severe intraventricular hemorrhage (grades III/IV). Prothrombin time, activated partial thromboplastin time, and fibrinogen levels were not significantly different between the two groups. However, the use of heparin was associated with a lower antithrombin III activity level. Antenatal indomethacin use was associated with a 2.9 increased risk of intraventricular hemorrhage (95% confidence interval, 1.15 to 7.17).
Conclusion:
A low dose of heparin added to umbilical catheter infusates does not increase the incidence or severity of intraventricular hemorrhage or significantly alter the coagulation profile in premature infants.
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