Mitsiakos George, Papaioannou Georgia, Papadakis Emmanouil, Chatziioannidis Elias, Giougi Evaggelia, Karagianni Paraskevi, Evdoridou Joanna, Malindretos Pavlos, Athanasiou Miranda, Athanassiadou Fani, Nikolaidis Nikolaos
2nd NICU and Nueonatology Department of Aristotle University of Thessaloniki, GPN Papageorgiou, Thessaloniki, Greece.
Thromb Res. 2009 Jul;124(3):288-91. doi: 10.1016/j.thromres.2008.08.008. Epub 2008 Oct 17.
Small for Gestational Age (SGA) neonates often appear with haemostatic alterations, principally due to hepatic dysfunction that results from chronic intrauterine hypoxia. Polycythaemia and thrombocytopenia are common findings in this neonatal population.
We performed a comparison of coagulation, natural inhibitors and fibrinolysis between SGA and Appropriate for Gestational Age (AGA) infants born full term [gestational age (G.A.) >37 weeks]. Study population consisted of 188 healthy newborns, 90 of whom were SGA (62 females and 28 males), while the rest were the control group (44 females and 54 males). Blood samples were obtained within 30 minutes following birth and before the administration of vitamin K. Investigation included: PT, INR, APTT, fibrinogen, coagulation factors II, V, VII, VIII, IX, X, XI, XII, vWillebrand factor, protein C and free protein S, antithrombin (AT), APCR, tPA and PAI-1. The independent t-test was used to compare the differences between the values of haemostatic parameters.
Statistical analysis revealed a significant prolongation in PT, INR, elevated levels of tPA (p<0.015, 0.01 and 0.002 respectively) and a decrease in the values of XII and free protein S (p<0.045 and 0.007 respectively) in SGA full term neonates. The two groups had similar demographic characteristics (except birth weight), without significant differences in the values of other haemostatic parameters.
Despite of statistically significant differences in PT, INR, values of tPA, XII and free protein S, levels of haemostatic factors range within laboratory references for healthy full term newborns. These findings were not accompanied with clinical manifestations of altered haemostasis.
小于胎龄（SGA）新生儿常出现止血功能改变，主要是由于慢性宫内缺氧导致肝功能障碍。红细胞增多症和血小板减少症在这一新生儿群体中很常见。
我们对足月出生[胎龄（G.A.）>37周]的SGA和适于胎龄（AGA）婴儿的凝血、天然抑制剂和纤维蛋白溶解进行了比较。研究人群包括188名健康新生儿，其中90名是SGA（62名女性和28名男性），其余为对照组（44名女性和54名男性）。出生后30分钟内且在给予维生素K之前采集血样。检查项目包括：凝血酶原时间（PT）、国际标准化比值（INR）、活化部分凝血活酶时间（APTT）、纤维蛋白原、凝血因子II、V、VII、VIII、IX、X、XI、XII、血管性血友病因子、蛋白C和游离蛋白S、抗凝血酶（AT）、活化蛋白C抵抗（APCR）、组织型纤溶酶原激活物（tPA）和纤溶酶原激活物抑制剂-1（PAI-1）。采用独立t检验比较止血参数值之间的差异。
统计分析显示，足月SGA新生儿的PT、INR显著延长，tPA水平升高（分别为p<0.015、0.01和0.002），XII和游离蛋白S值降低（分别为p<0.045和0.007）。两组具有相似的人口统计学特征（出生体重除外），其他止血参数值无显著差异。
尽管PT、INR、tPA、XII和游离蛋白S值存在统计学显著差异，但止血因子水平在健康足月新生儿的实验室参考范围内。这些发现并未伴有止血功能改变的临床表现。
