Department of Surgical and Medical Critical Care, Section of Neonatology, Careggi University Hospital of Florence, Florence, Italy.
Transfusion. 2009 Dec;49(12):2637-44. doi: 10.1111/j.1537-2995.2009.02328.x. Epub 2009 Jul 22.
Despite the improvement in the assistance and treatment of preterm infants, intraventricular hemorrhage (IVH) remains a frequent complication in these patients. Our aim was to demonstrate the hypothesis that a coagulopathy screening and the early treatment with fresh-frozen plasma (FFP) of proven coagulopathy may contribute to decrease the occurrence of IVH in infants with gestational age of less than 29 weeks.
This study compared two cohorts of infants who received FFP (10 mL/kg) after the evidence of pathologic coagulation tests performed within 2 hours after birth (screening group, n = 127) or after the development of bleedings and evidence of pathologic coagulation tests (no-screening group, n = 91).
The screening strategy decreased the relative risk (RR) of developing IVH (RR = 0.65; 95% confidence interval, 0.44-0.98) compared to no-screening strategy, but the effect was limited to infants born at 23 to 26 weeks of gestation in whom screening strategy lowered IVH occurrence (34.5% vs. 61.1%, p = 0.008).
A coagulopathy screening strategy decreases the risk of developing IVH in preterm infants but this effect is limited to infants born at 23 to 26 weeks of gestation.
尽管早产儿的辅助治疗有所改善，但脑室内出血（IVH）仍是这些患者的常见并发症。我们旨在证明以下假说，即凝血功能障碍筛查以及对证实存在凝血功能障碍的患者早期应用新鲜冷冻血浆（FFP）治疗，可能有助于降低胎龄小于 29 周的婴儿发生 IVH 的几率。
本研究比较了两组婴儿，一组在出生后 2 小时内进行凝血功能异常检查后给予 FFP（10 mL/kg）（筛查组，n = 127），另一组在出现出血和凝血功能异常检查后给予 FFP（无筛查组，n = 91）。
与无筛查策略相比，筛查策略降低了发生 IVH 的相对风险（RR=0.65；95%置信区间，0.44-0.98），但这种效果仅限于胎龄为 23 至 26 周的婴儿，在这些婴儿中，筛查策略降低了 IVH 的发生（34.5%比 61.1%，p = 0.008）。
凝血功能障碍筛查策略可降低早产儿发生 IVH 的风险，但这种效果仅限于胎龄为 23 至 26 周的婴儿。
