Clinical Characteristics of Hospitalized Neonates With Hypofibrinogenemia: A Retrospective Cohort Study

Abstract

Background: Neonatal hypofibrinogenemia is often asymptomatic but can manifest as hemorrhage. Objective: This study was conducted to characterize clinical characteristics of neonates with hypofibrinogenemia and identify factors associated with hemorrhage. Methods: This was a retrospective study of neonates with plasma fibrinogen level (FIB) ≤1.0 g/L who were hospitalized at the Neonatology Department, People's Hospital, Chongqing, China, from January 2012 to December 2017. Based on severity, patients were grouped into severe, moderate, and mild hypofibrinogenemia (FIB < 0.5 g/L, 0.5 g/L ≤ FIB <0.7 g/L, and 0.7 g/L ≤ FIB ≤ 1.0 g/L, respectively). Clinical characteristics associated with hemorrhage were analyzed. Results: Among 330 neonates, 52.7% showed mild hypofibrinogenemia, 25.5% had moderate hypofibrinogenemia, and 21.8% had severe hypofibrinogenemia. Severe hypofibrinogenemia was not associated with gestational age, but the mild form was frequent in neonates with low/normal birthweight (P = 0.018). Approximately 80.6% of neonates presented hypofibrinogenemia as variable combinations of thrombocytopenia or coagulopathies. Hemorrhage occurred in 38.8% of the cases, 60.9% of which were mild. Hemorrhage manifested as puncture site bleeding (47.7%) or spontaneous skin/mucous membrane bleeding (34.2%). The degree of hypofibrinogenemia was not associated with the severity or occurrence of hemorrhage. Among patients with hypofibrinogenemia and bleeding, 53.4% of the cases with coagulopathies showed mild hemorrhage, 85.7% of the cases with thrombocytopenia had moderate bleeding, while 53.8% of the cases with coagulopathy and thrombocytopenia showed severe hemorrhage. Conclusion: Neonatal hypofibrinogenemia is often comorbid and occurs with thrombocytopenia and/or coagulopathies. Although hemorrhage is not associated with the degree of hypofibrinogenemia, it may be severe when hypofibrinogenemia co-occurs with coagulopathies and/or thrombocytopenia.

Potential predictors of necrotizing enterocolitis in extremely low-birth-weight infants: Analyses of coagulation and fibrinolysis markers at birth at a single institution during the past decade

“…In neonates, hypofibrinogenemia is associated with low birth weight, and when hypofibrinogenemia is diagnosed, screening for other coagulation abnormalities is important. In most cases, hypofibrinogenemia occurs concomitantly with other coagulation abnormalities and/or thrombocytopenia, which suggests that physiological immaturity and hepatic dysfunction are the primary causes of hypofibrinogenemia [19]. In the present study, the NEC group showed hypofibrinogenemia and a significantly higher DD level in comparison to the control group.…”

Congenital Hypofibrinogenemia in a Neonate with a Novel Mutation in the FGB Gene

“…Zhou et al classified hospitalized neonates with hypofibrinogenemia (including acquired cases) into severe (FIB < 50 mg/dL), moderate (50–70 mg/dL), and mild (70–100 mg/dL) groups, based on their clinical characteristics. Severe hemorrhage may develop when hypofibrinogenemia co-occurs with either coagulopathies, thrombocytopenia, or both, and does not depend on the degree of hypofibrinogenemia alone [ 11 ]. In cases of neonatal congenital afibrinogenemia/hypofibrinogenemia, hemorrhagic symptoms such as antenatal intracranial bleeding and umbilical cord bleeding, have mostly been reported in afibrinogenemia [ 12 , 13 , 14 , 15 , 16 ] but rarely in hypofibrinogenemia [ 17 , 18 ].…”