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Coagulation activation, fibrinolysis and inhibitors in neonates
S C Koh1, Y C Cheong, S Arulkumaran
1University Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
Insights
Neonates exhibit enhanced coagulation and fibrinolysis, with elevated plasminogen activator inhibitor-I (PAI-1) potentially preventing hemorrhage. These hemostatic mechanisms in healthy neonates mirror those in infants of mothers with gestational diabetes mellitus (GDM).
Area of Science:
- Neonatal physiology
- Hemostasis and thrombosis
- Fibrinolysis
Background:
- Neonates display unique hemostatic profiles compared to adults.
- Understanding these mechanisms is crucial for neonatal health and managing bleeding risks.
Purpose of the Study:
- To investigate the hemostatic and fibrinolytic status in healthy neonates.
- To compare these mechanisms between neonates born to mothers with and without gestational diabetes mellitus (GDM).
Main Methods:
- Analysis of coagulation activation markers.
- Measurement of antithrombin III (ATIII) activity.
- Assay of fibrinolytic components including tissue plasminogen activator (t-PA), urokinase-like plasminogen activator (u-PA), D-dimer, plasminogen, and plasminogen activator inhibitor-I (PAI-1).
Main Results:
- Healthy neonates showed enhanced coagulation activation and reduced ATIII activity.
- Elevated D-dimer and low plasminogen indicated enhanced fibrinolysis.
- Plasminogen activator inhibitor-I (PAI-1) levels were elevated, counteracting fibrinolysis.
- Hemostatic and fibrinolytic profiles were similar in neonates from normal pregnancy and GDM mothers.
Conclusions:
- Elevated PAI-1 in neonates may offer protection against hemorrhage.
- Neonatal hemostasis and fibrinolysis are similar in healthy neonates and those born to GDM mothers.
- Further research is needed in neonates with adverse outcomes to fully assess their hemostatic status.
Abstract:
Enhanced coagulation activation with reduced antithrombin III (ATIII) activity was seen in healthy neonates. Although systemic tissue plasminogen activator (t-PA) and urokinase-like plasminogen activator (u-PA) levels showed no significant differences from normal adults, enhanced fibrinolysis was indicated by elevated D-dimer and low plasminogen levels in the neonates in this study. Enhanced fibrinolysis observed was countered by elevated plasminogen activator inhibitor-I (PAI-1) levels, a trend similar to that observed in the amniotic fluid during labour. The elevated PAI-1 level seen in neonates may have a beneficial effect in preventing haemorrhage in the neonatal period. The haemostatic and fibrinolytic mechanisms studied in normal pregnancy neonates were similar to neonates born to gestational diabetes mellitus (GDM) mothers. Further studies need to include neonates with poor outcome and low Apgar score to assess their haemostatic status.