Hemostatic profile in healthy premature neonates; Does birth weight affect the coagulation profile?

Abstract

Context:There are limited studies assessing the neonatal hemostatic factors in relation to birth weight.Aims:This study aims to compare the coagulation factors between three groups of neonates with different birth weight for gestational age (GA).Settings and Design:In a cross-sectional study, 74 healthy premature neonates were involved.Subjects and Methods:Serum prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), thrombin clotting time (TT), and levels of fibrinogen, anti-thrombin III, protein S and protein C were measured. Neonates were classified into three groups according to birth weight, including small, appropriate and large for gestational age (SGA, AGA, and LGA).Statistical Analysis Used:Statistical analysis was performed using SPSS software.Results:There was a significant difference in the levels of protein S (P < 0.001), protein C (P = 0.004), and values of APTT (P = 0.01) between three groups. Other coagulation factors however, did not represent a significant pattern (P > 0.05). Protein S concentration, directly (B = 0.78, P < 0.001), and APTT, inversely (B = −0.29, P = 0.03), associated with birth weight after adjustment for GA and sex.Conclusions:Despite the decrease in APTT from SGA to AGA, and LGA neonates, levels of protein S increases directly with birth weight. However, no other coagulation factors revealed an explainable pattern in relation to the state of SGA, AGA, or LGA.

Assessment of Hemostatic Profile in Neonates with Intrauterine Growth Restriction: A Systematic Review of Literature

“…However, Perlman and Dvilansky 64 found no difference in levels of factors V and VIII. Plasma concentrations of inhibitors of coagulation, such as protein S and antithrombin, were lower in FGR infants, although one study reported high levels of protein C. 14,71,75 Increased levels of tPA 14,70 and lower plasma fibrinogen were also reported, 13,65,68,70 although these observations were not confirmed in other studies. 64,69 No difference in plasminogen levels is usually noted; 69 however, one paper claimed a decrease in plasminogen levels in IUGR term neonates, especially when complications in the perinatal period occurred.…”

“…13 As stated above, liver is one of the first organs affected by chronic hypoxia and as such the production of proteins, such as clotting factors, could be reduced. As for standard coagulation tests, PT, APTT and INR are usually prolonged, 11,14,64,65,68,71 although some studies detected no difference in these parameters in SGA vs AGA infants. 66,72 Among the few studies that investigated vitamin K-dependent coagulation factors II and X, they were not altered by growth restriction.…”

“…A possible explanation is that the studied population is diverse and that confounding factors affecting coagulation exist. 69,71 Time of blood collection, administration of vitamin K, gestational age of the neonate, presence of comorbidities such as sepsis or birth asphyxia and mode of delivery vary considerably; as a result, the interpretation of results should be carefully considered. Standard coagulation tests are used in everyday practice for the evaluation of coagulopathy and the need for fresh frozen plasma transfusion, 13 although their capacity to reflect the hemostatic system as a whole and their ability to correlate with hemorrhagic manifestations is limited.…”

“…Abdollahi et al, 71 using cord blood samples, assessed hemostatic parameters in preterm infants before the administration of vitamin K. Besides lower platelet count, APTT was prolonged in SGA neonates compared with AGA and LGA groups. For inhibitors of coagulation, protein S levels were reduced, while protein C was elevated.…”

Faktor Risiko Terhadap Kejadian Gangguan Koagulasi pada Neonatus

“…Hal ini sejalan dengan penelitian sebelumnya oleh Salonvaara dkk 9 yang mendeteksi penurunan pada faktor V dan faktor VII pada bayi KMK dibandingkan SMK. Abdollahi dkk 19 Salonvaara dkk 9 melaporkan bahwa bayi asfiksia dengan skor APGAR <7 pada menit ke-5 mengalami pemanjangan studi koagulasi berupa faktor II, V, VII, X, dan pemanjangan prothrombin, sedangkan partial thomboplastin time tidak memanjang. Studi lain oleh Murthy dkk 22 melaporkan bahwa bayi dengan asfiksia berat (skor APGAR <7 pada menit ke-5) mengalami pemanjangan PTTK (pemanjangan jika nilai lebih besar dari kontrol).…”