Department of Neonatology, Rotunda Hospital, Dublin, Ireland.
Department of Paediatrics, Royal College of Surgeons, Dublin, Ireland.
J Thromb Haemost. 2015 Nov;13(11):2021-30. doi: 10.1111/jth.13130. Epub 2015 Sep 25.
Very premature infants are at high risk of bleeding complications; however, few data exist on ranges for standard coagulation tests.
The primary objective of this study was to measure standard plasma coagulation tests and thrombin generation in very premature infants compared with term infants. The secondary objective was to evaluate whether an association existed between coagulation indices and intraventricular hemorrhage (IVH).
PATIENTS/METHODS: Cord and peripheral blood of neonates < 30 weeks gestational age (GA) was drawn at birth, on days 1 and 3 and fortnightly until 30 weeks corrected gestational age. Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen and coagulation factor levels were measured and tissue factor-stimulated thrombin generation was characterized. Control plasma was obtained from cord blood of term neonates.
One hundred and sixteen infants were recruited. Median (range) GA was 27.7 (23.7-29.9) weeks and mean (SD) birth weight was 1020 (255) g. Median (5th-95th percentile) day 1 PT, APTT and fibrinogen were 17.5 (12.7-26.6) s, 78.7 (48.7-134.3) s and 1.4 (0.72-3.8) g L(-1) , respectively. No difference in endogenous thrombin potential between preterm and term plasma was observed, where samples were available. Levels of coagulation factors II, VII, IX and X, protein C, protein S and antithrombin were reduced in preterm compared with term plasma. Day 1 APTT and PT were not associated with IVH.
In the largest cross-sectional study to date of very preterm infants, typical ranges for standard coagulation tests were determined. Despite long clotting times, thrombin generation was observed to be similar in very preterm and term infants.
极早产儿出血并发症风险高，但关于标准凝血检测范围的数据较少。
本研究主要目的是比较极早产儿和足月产儿的标准血浆凝血检测和凝血酶生成情况。次要目的是评估凝血指数与脑室周围出血（IVH）之间是否存在关联。
患者/方法：<30 孕周的新生儿于出生时、第 1 天和第 3 天及出生后每两周采脐血和外周血，直至校正胎龄 30 周。检测凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原和凝血因子水平，并对组织因子诱导的凝血酶生成进行特征分析。从足月产儿的脐血中获得对照血浆。
共纳入 116 例婴儿。中位（范围）胎龄为 27.7（23.7-29.9）周，平均（标准差）出生体重为 1020（255）g。第 1 天 PT、APTT 和纤维蛋白原中位数（第 5 百分位数至第 95 百分位数）分别为 17.5（12.7-26.6）s、78.7（48.7-134.3）s 和 1.4（0.72-3.8）g·L^-1。在有样本的情况下，未观察到早产儿和足月产儿血浆内源性凝血酶潜能存在差异。与足月产儿相比，早产儿血浆中凝血因子 II、VII、IX、X、蛋白 C、蛋白 S 和抗凝血酶的水平降低。第 1 天的 APTT 和 PT 与 IVH 无关。
本研究是迄今为止关于极早产儿的最大横断面研究，确定了标准凝血检测的典型范围。尽管凝血时间较长，但极早产儿和足月产儿的凝血酶生成情况相似。
