Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Clin Chem Lab Med. 2021 Nov 9;60(2):261-270. doi: 10.1515/cclm-2021-0967. Print 2022 Jan 27.
The coagulation system is not fully developed at birth and matures during the first months of infancy, complicating clinical decision making within hemostasis. This study evaluates coagulation parameters at birth and two months after birth, and tests whether cord blood can be used as a proxy for neonatal venous blood measurements.
The Copenhagen Baby Heart Study (CBHS) and the COMPARE study comprise 13,237 cord blood samples and 444 parallel neonatal venous blood samples, with a two month follow-up in 362 children.
Because coagulation parameters differed according to gestational age (GA), all analyses were stratified by GA. For neonatal venous blood, reference intervals for activated partial thromboplastin time (APTT) and prothrombin time (PT) were 28-43 s and 33-61% for GA 37-39 and 24-38 s and 30-65% for GA 40-42. Reference intervals for international normalized ratio (INR) and thrombocyte count were 1.1-1.7 and 194-409 × 10/L for GA 37-39 and 1.2-1.8 and 188-433 × 10/L for GA 40-42. Correlation coefficients between umbilical cord and neonatal venous blood for APTT, PT, INR, and thrombocyte count were 0.68, 0.72, 0.69, and 0.77 respectively, and the distributions of the parameters did not differ between the two types of blood (all p-values>0.05).
This study describes new GA dependent reference intervals for common coagulation parameters in newborns and suggests that cord blood may serve as a proxy for neonatal venous blood for these traits. Such data will likely improve clinical decision making within hemostasis among newborn and infant children.
出生时凝血系统尚未完全发育成熟，并在婴儿期的头几个月成熟，这使得在止血方面的临床决策变得复杂。本研究评估了出生时和出生后两个月的凝血参数，并检验了脐血是否可以作为新生儿静脉血测量的替代物。
哥本哈根婴儿心脏研究（CBHS）和 COMPARE 研究共包含 13237 份脐血样本和 444 份平行的新生儿静脉血样本，其中 362 名儿童进行了两个月的随访。
由于凝血参数因胎龄（GA）而异，因此所有分析均按 GA 分层。对于新生儿静脉血，激活部分凝血活酶时间（APTT）和凝血酶原时间（PT）的参考区间分别为 GA 37-39 为 28-43 s 和 33-61%，GA 40-42 为 24-38 s 和 30-65%。国际标准化比值（INR）和血小板计数的参考区间分别为 GA 37-39 为 1.1-1.7 和 194-409×10/L，GA 40-42 为 1.2-1.8 和 188-433×10/L。脐血和新生儿静脉血之间 APTT、PT、INR 和血小板计数的相关系数分别为 0.68、0.72、0.69 和 0.77，两种类型血液之间参数的分布无差异（所有 p 值均>0.05）。
本研究描述了新生儿常见凝血参数新的 GA 依赖性参考区间，并提示脐血可能可作为这些特征的新生儿静脉血的替代物。这些数据可能会改善新生儿和婴儿期止血方面的临床决策。
