Hemostatic profile of infants with spontaneous prematurity: can we predict intraventricular hemorrhage development?

Audrey Hochart,Jenny Goudemand,Adeline Pierache,Antoine Rauch,Alexandra Nuytten,Sophie Susen,Bénédicte Wibaut,Anne Bauters

doi:10.1186/s13052-019-0709-8

Abstract

BackgroundDefining hemostatic profile for preterm infants is a challenge when severe bleedings are frequent.MethodsThe aim was to define the hemostatic profile at birth of infants with spontaneous prematurity and to evaluate whether characteristic profiles can predict the development of intraventricular hemorrhage (IVH) in prematures.ResultsWe included 122 newborns with a median age of 315/7 gestational age (GA) [292/7;340/7] and median weight of 1145 g [785;1490]. Levels of fibrinogen, factor II (FII) and factor V (FV) rose with GA (p = 0.017,p = 0.009, p = 0.001). In the group of 230/7 – 286/7 GA, the 5th percentile was defined as 0.6 g/L for fibrinogen, 15 IU/dL for FII and 16 IU/dL for factor V (n = 30). In the group of 290/7–326/7 GA, the 5th percentile was defined as 1.0 g/L for fibrinogen, 24 IU/dL for FII and 41 IU/dL for factor V (n = 46). In the group of 330/7–366/7 GA, the 5th percentile was defined as 1.0 g/L for fibrinogen, 24 IU/dL for FII and 30 IU/dL for factor V (n = 46). Level of fibrinogen was higher in case of vaginal delivery and lower in case of IUGR. Only lower level of FV at birth was significantly associated with IVH (63.5 [46.0; 76.5] vs 74.0 [58.0; 89.0], p = 0.026) with an unadjusted OR per SD increase in FV of 0.57 (95%CI, 0.34 to 0.96). After adjustment for age, the association between FV level and IVH was slightly attenuated (adjusted OR, 0.70; 95%CI, 0.40 to 1.23) but remained not significant (p = 0.22).There was no correlation with FII and fibrinogen.ConclusionsWe can define hemostastic profile of prematures and corroborate references ranges for studied parameters. Further large studies are still called for, to correlate the grade of hemorrhage and the factor V level at birth.

Highlights

The coagulation system of the newborn differs from that of adults, and among full-term newborn, premature newborn and fetus, the hemostatic balance is different
The aim of this study was to define the hemostatic profile of premature infants and to evaluate whether characteristic profiles can predict the development of intraventricular hemorrhage (IVH) in premature infant
None of the mother received medications like anticoagulants or antiepleptics and none of the mothers presented with thrombocytopenia related with immune disorder

Summary

Introduction

The coagulation system of the newborn differs from that of adults, and among full-term newborn, premature newborn and fetus, the hemostatic balance is different. This is the developmental hemostasis concept [1,2,3,4,5]. The premature hemostatic balance is an evolving process depending on fetal hepatic maturation (increasing with gestational age) and the maturation inherent to birth (especially the effect of labour on the coagulation system) [6]. Data from fetus are considering only fetal hepatic maturation whereas it was demonstrated that there is an effect of labour and birth itself on the coagulation system in the neonate [6, 7]. Defining hemostatic profile for preterm infants is a challenge when severe bleedings are frequent

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