Abstract
Introduction: Perinatal asphyxia is a common problem with devastating consequences in neonatal practice. Bleeding due to coagulation abnormality is very common and is potentially treatable. Various mechanisms includi ng liver dysfunction, unresponsiveness to Vitamin K and consumption of coagulation factors all have been implic ated in severe bleeding in asphyxiated neonates. The magnitude of this problem and therapeutic window if present has not been well studied. Methods: this was a prospective study undertaken in a terti ary care centre. 20 babies were recruited for the study. Asphyxia was defined on pragmatic basis of Apgar score and need for resuscitation followed by c linical course. The blood sample was collected in citrated tubes an d analysed for coagulation parameters. Results: 55% of our subjects were having deranged coagulation. APTT was the commonest deranged parameters in all our subjects (11/2 0). PT was deranged in only 2 of 20 patients. Patients who had deranged coagulation had poor outcomes. Coagulation abnormalities within first 24 hours had a positive predictive val ue of 18% and negative predictive value of 100% wit h respect to later bleeding. Conclusion: Deranged coagulation is very common in asphyxiated neonates and is associated with poor outcome.
Highlights
Perinatal asphyxia is a common problem with devastating consequences in neonatal practice
Recognizing coagulation status earlier to clinical bleeding may have a role in early intervention to prevent life threatening bleeding
Median APGAR at 1 minute was 4 with interquartile range between 3 and 5, at five minutes was 7 with interquartile range between 7 and 8 of these babies developed hypoxic ischemic encephalopathy and out of them 3 had renal dysfunction as well. 3 babies had GI bleed during the time of sampling and 2 of them turned out to be having prolonged coagulation
Summary
Perinatal asphyxia has been recognized as common cause of newborn death since few centuries. Studies have shown that there are multiple mechanism including liver dysfunction [3] and consumption of coagulation [4] factors as cause of deranged coagulation in these babies. Mechanism of developing coagulation derangement [6] In view of this observation, few clinicians recommended giving fresh frozen plasma to all newborn asphyxiated babies with an aim of reducing intracranial bleed and death consequent to it. Various studies conducted for different purposes have shown that coagulation system gets deranged in birth asphyxia and other causes of respiratory failure [8, 9]. There have been significant advancements in managing asphyxiated neonate over last few decades This brings us the opportunity to relook at this important problem and formulate management strategy. Primary objective: To estimate the magnitude of coagulation derangement in babies who suffered birth asphyxia
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