Background: Few published data exist to guide interpretation of coagulation times in extremely premature infants. Objective: To determine coagulation reference ranges on day 1 of life in extremely premature infants. Methods: A retrospective review of day 1 coagulation tests was performed in 144 infants <27 weeks' gestation between 2004 and 2010 in a tertiary neonatal unit. Samples were drawn through a non-heparinized umbilical or peripheral venous catheter as part of routine clinical care. Results: Mean (SD) and median (range) prothrombin times (PT) of 21.5 (5.3) and 20.2 (13.3-39) s, respectively, activated partial thromboplastin times (APTT) of 75.2 (27.8) and 67.4 (34.9-191.6) s, respectively, and plasma fibrinogen levels of 1.9 (1.1) and 1.4 (0.5-4.8) g/l, respectively, were reported. Using reference intervals derived from the 2.5th to 97.5th centiles, ranges of 14.4-36.7 s, 40.5-158.5 s and 0.7-4.8 g/l were determined for PT, APTT and plasma fibrinogen levels, respectively. In a subcohort with grade 0-2 intraventricular haemorrhage (n = 92), mean PT and APTT were 20.9 and 71.3 s, respectively, versus mean PT and APTT of 23.1 and 88.4 s (p = 0.06 and p = 0.03), respectively for those with grade 3-4 intraventricular haemorrhage. Mean PT and APTT in a cohort of infants defined to be small for gestational age were 22 and 76.8 s. These results did not differ significantly from non-small for gestational age infants, with a mean PT and APTT of 19.5 and 73.4 s (p = 0.09 and p = 0.7). Conclusions: Reference ranges based on retrospective data were determined for PT, APTT and fibrinogen in a large cohort of extremely preterm infants.

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Objective: To evaluate the effectiveness of oral sucrose as analgesic for minor painful procedures in neonates. Methods: A case control study was conducted in the neonatal intensive care unit at King Hussein Medical Center during the period between June 1 and December 30, 2009. A total of 100 preterm and term neonates with postnatal ages ranging from one to 20 days, who underwent heel pricks for collection of blood for bilirubin estimation were randomly assigned into two groups. The treatment group received 24% sucrose solution two minutes before heel prick and the control group did not receive sucrose solution. The pain was assessed using the Premature Infant Pain Profile which is a multidimensional acute pain rating scale with scores ranging from 0 (no pain) to 21 (maximum pain). The exclusion criteria included the following: age less than 30 weeks gestational age, newborns on ventilators, newborns with major congenital or neurologic anomalies or clinical diagnosis of birth asphyxia or seizures, those on analgesics or sedatives and sick newborns with unstable vital signs. The student's t test was used to compare the relevant data. P value less than 0.05 was considered to indicate statistical significance. Results: A total of 100 newborns, who were born with 30 weeks and above gestational age, were included in the study and divided into treatment and control groups in equal numbers. The mean Premature Infant Pain Profile scores were significantly lower in the treatment group, than in the control. Conclusion: Our study suggests that sucrose is an effective non-pharmacological analgesic for minor painful procedures in neonates.

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