Neonatal Coagulopathy in Preterm, Small-for-Gestational-Age Infants

Hannam, Simon; Lees, C.; Edwards, Rebecca J.; Greenough, Anne

doi:10.1159/000068928

Cited by 21 publications

(17 citation statements)

References 14 publications

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“…Intrauterine hypoxia can also lead to intrauterine growth restriction causing a small for gestational age (SGA) foetus. Elevated international normalized ratio (INR) has been previously reported in preterm small for gestational age (SGA) infants and it has been suggested that the coagulopathy in preterm SGA infants might at least be partially explained by antenatal hypoxia affecting the liver and hence vitamin K‐dependent coagulation.…”

Section: Discussionmentioning

confidence: 99%

The effect of labour on the coagulation system in the term neonate

et al. 2013

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The coagulation system of the foetus is markedly different from that of adults. To assess the influence of maternal age, mode of delivery and intrapartum events, and foetal gender and weight on the foetal coagulation system. Cord blood was collected from 154 healthy pregnant women, with gestational age 37 - 42 weeks at birth. Mann-Whitney test was used for analysis of binary data and continuous variables were analysed using Pearson's correlation coefficient. Mean cord blood levels of FVIII:C, VWF:Ag, VWF:CB, FIX, FXI, FXII and plasminogen were significantly higher in babies delivered after labour, compared to those delivered after an elective caesarean. Mean cord blood levels of FII (P = 0.003), FV (P = 0.009), FVII (P = 0.0004) and FX (P = 0.0009) were significantly lower in the babies with meconium stained liquor in labour, compared with those with clear liquor. Augmentation with oxytocin, instrumental delivery, did not affect any of the factor levels and duration of labour did not have an effect on the level of coagulation proteins in cord blood. This study provides valuable information about effect of labour on the coagulation system of the foetus. It is concluded that, in cord blood, the results of coagulation parameters in the newborn baby should be considered in light of mode of delivery and events of labour.

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Section: Discussionmentioning

confidence: 99%

The effect of labour on the coagulation system in the term neonate

et al. 2013

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“…Increased erythropoiesis (Philip & Tito, 1989) and polycythemia (De Grauw et al, 1991;Maertzdorf et al, 1991), elevated international normalized ratio, and decreased plasma levels of antithrombin and fibrinolysis inhibitor alpha-1-antityripsin (Peters et al, 1984;Hannam et al, 2003) are some of the hematological abnormalities seen in this group of newborns. However, no randomized study has yet investigated all CBC parameters and peripheral blood differential counts in SGA neonates.…”

Section: Introductionmentioning

confidence: 96%

“…, 1991), elevated international normalized ratio, and decreased plasma levels of antithrombin and fibrinolysis inhibitor alpha‐1‐antityripsin (Peters et al. , 1984; Hannam et al. , 2003) are some of the hematological abnormalities seen in this group of newborns.…”

Section: Introductionmentioning

confidence: 99%

Complete blood count parameters for healthy, small-for-gestational-age, full-term newborns

et al. 2006

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No previous study has investigated the full range of complete blood count (CBC) parameters in small-for-gestational-age (SGA) newborns. The main aim of this study was to compare CBC and peripheral smear parameters in term, healthy SGA neonates and appropriate-for-gestational-age (AGA) neonates, and to establish CBC reference values for full-term SGA newborns. One hundred thirty-two healthy, term newborns (73 SGA and 59 AGA) were included. On day 1, we obtained 109 samples and on day 7 we obtained 77 samples. A CBC and peripheral smear were analyzed for each sample collected and group data were compared. We observed higher mean values for normoblast count, hemoglobin, hematocrit, and red blood cell (RBC) count in the SGA babies than in the AGA babies on day 1. The mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration values for the SGA babies were decreased because of the relatively high RBC count and relatively high mean corpuscular volume we observed in this group. Of the SGA newborns, 21.9% had neutropenia and 4.7% had absolute neutrophil counts lower than 1500/microl on day 1. On both day 1 and day 7, the SGA newborns had higher mean absolute metamyelocyte counts and higher mean I : T (immature : total neutrophil ratio) values than the AGA group. The SGA babies had a lower mean absolute lymphocyte count on day 7 than the AGA group. We detected thrombocytopenia in almost one-third of the 64 SGA newborns tested on day 1. In summary, our study clearly demonstrates that CBC parameters for healthy, full-term, SGA newborns are different from those of healthy, term AGA newborns. This is the first study that has documented different mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, metamyelocyte counts, lymphocyte counts, and I : T in SGA babies compared with AGA babies.

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“…Nicolini et al [11] demonstrated a positive correlation between NRBC count and aspartate transaminase levels at birth in Rh alloimunization and suggested that extramedullary erythropoiesis can lead to liver dysfunction. Finally, Hannam et al [12] have shown a higher incidence of abnormal INR values in growth-restricted infants compared to appropriate for gestational age controls. These results support our hypothesis that massively elevated NRBC could be a warning sign for liver dysfunction with coagulopathy regardless of the underlying cause of extramedullary erythropoiesis (i.e., rhesus isoimmunization or chronic hypoxia due to placental insufficiency).…”

Section: Discussionmentioning

confidence: 97%

Massively Elevated Nucleated Red Blood Cells and Cerebral or Pulmonary Hemorrhage in Severely Growth-Restricted Infants – Is There More than Coincidence?

Steurer

Berger²

2008

Neonatology

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Background: An elevated nucleated red blood cell (NRBC) count is an independent risk factor for postnatal bleeding complications in growth-restricted infants. The etiology of this phenomenon is unclear. Objectives: To demonstrate a correlation between massively elevated NRBC counts, coagulopathies and unusual or severe bleeding complications. Methods: The medical records of all severely growth-restricted very low birth weight (VLBW) infants (gestational age <32 0/7 weeks and birth weight at or below the third percentile) admitted to the Neonatal and Pediatric Intensive Care Unit of the Children’s Hospital of Lucerne over a 6-year period were reviewed. NRBC counts and coagulation profiles of infants with unusual and/or severe bleeding complications were compared with those of infants without such complications. Results: From a total of 20 severely growth-restricted VLBW infants, 6 had severe or atypical bleeding complications. Among the infants with hemorrhagic complications, the NRBC counts were significantly higher than in the group without such complications (median 24.2 vs. 4.5 × 10⁹/l, p = 0.028). In 2 infants with severe bleeding complications, in whom coagulation studies were performed prior to the occurrence of the hemorrhagic complications, severe clotting abnormalities in addition to massively elevated NRBC counts were detected. Conclusions: In infants with massively elevated NRBC counts, coagulation studies should be performed. Early and aggressive support of the coagulation system may help to prevent severe bleeding complications in such patients.

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Neonatal Coagulopathy in Preterm, Small-for-Gestational-Age Infants

Cited by 21 publications

References 14 publications

The effect of labour on the coagulation system in the term neonate

The effect of labour on the coagulation system in the term neonate

Complete blood count parameters for healthy, small-for-gestational-age, full-term newborns

Massively Elevated Nucleated Red Blood Cells and Cerebral or Pulmonary Hemorrhage in Severely Growth-Restricted Infants – Is There More than Coincidence?

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