Bleeding & Clotting Disorders Institute, Peoria, Illinois, USA.
Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA.
J Thromb Haemost. 2022 Aug;20(8):1797-1807. doi: 10.1111/jth.15755. Epub 2022 May 22.
Extremely premature neonates have increased risk for bleeding, perhaps the most devastating version of which being intraventricular hemorrhage (IVH). Limited data are available for coagulation parameters in this vulnerable population.
We conducted a prospective cohort study characterizing coagulation laboratory parameters in extremely premature neonates 23-30 weeks gestational age (GA) and determined coagulation parameters and clinical risk factors associated with IVH.
PATIENTS/METHODS: One hundred twenty neonates 23-30 weeks GA were enrolled, and umbilical cord blood samples were obtained and processed at the time of birth. Coagulation parameters including prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and activity assays for factors II, VII, IX, X, XIII, and XIII subunit A antigen were performed by standard methods. Clinical risk factors were analyzed for association with IVH.
Of the enrolled neonates, 29 (24.2%) experienced IVH. Persistent pulmonary hypertension (PPHN) independently predicted IVH risk with odds ratio (OR) 5.3 (95% confidence interval [CI] 1.1-24.3), P = .0338; and chronic lung disease (CLD) approached significance with OR 2.3 (95% CI 0.9-5.5), P = .0659. Coagulation parameters were evaluated for association with IVH, and there was no significant difference among coagulation tests in neonates with or without IVH or per GA. Reduced factor XIII subunit A showed significant association with death, P = .003.
We present a large, prospective study of laboratory coagulation parameters in extremely premature neonates, including factor X, factor XIII, and factor XIII subunit A not previously described in this population. These findings may impact clinical practice and should encourage additional study in this vulnerable population.
极早产儿出血风险增加，其中最严重的可能是脑室出血（IVH）。关于该脆弱人群的凝血参数，目前仅有有限的数据。
我们进行了一项前瞻性队列研究，以描述 23-30 孕周极早产儿的凝血实验室参数，并确定与 IVH 相关的凝血参数和临床危险因素。
患者/方法：共纳入 120 例 23-30 孕周的新生儿，在出生时采集脐血样本并进行处理。采用标准方法检测凝血参数，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），以及因子 II、VII、IX、X、XIII 和 XIII 亚单位 A 抗原的活性测定。分析临床危险因素与 IVH 的关系。
在纳入的新生儿中，有 29 例（24.2%）发生 IVH。持续性肺动脉高压（PPHN）独立预测 IVH 风险，比值比（OR）为 5.3（95%置信区间 [CI] 1.1-24.3），P =.0338；慢性肺病（CLD）也接近显著，OR 为 2.3（95% CI 0.9-5.5），P =.0659。评估凝血参数与 IVH 的关系，IVH 组和非 IVH 组或各胎龄组之间的凝血试验无显著差异。因子 XIII 亚单位 A 减少与死亡显著相关，P =.003。
我们进行了一项针对极早产儿实验室凝血参数的大型前瞻性研究，包括以前在该人群中未描述过的因子 X、因子 XIII 和因子 XIII 亚单位 A。这些发现可能会影响临床实践，并应鼓励在这一脆弱人群中进行更多的研究。
