Perinatal Factors Affecting Coagulation Parameters at Birth in Preterm and Term Neonates: A Retrospective Cohort Study

Abstract

To date, few studies have investigated whether perinatal factors affect coagulation parameters at birth in preterm and term neonates. We retrospectively investigated coagulation factors on day 1 in 609 consecutive neonates admitted to our neonatal intensive care unit between January 2010 and December 2017. We measured coagulation factors on day 1 using peripheral blood samples. Multivariate analysis revealed that prothrombin time–international normalized ratio correlated with intraventricular hemorrhage (p = 0.000; β = 0.180) and placental abruption (PA; p = 0.000; β = 0.142). Activated partial thromboplastin time (aPTT) correlated with birth weight (BW; p = 0.000; β = − 0.217), gestational age (GA; p = 0.000; β = − 0.282), and PA (p = 0.000; β = 0.181). Fibrinogen concentration was associated with respiratory distress syndrome (p = 0.007; β = − 0.114), pregnancy-induced hypertension (p = 0.000; β = − 0.141), and Apgar score at 1 minute (p = 0.043; β = 0.147). Furthermore, the level of d-dimer inversely correlated with Apgar score at 5 minutes (p = 0.049). Finally, antithrombin III levels positively correlated with GA (p = 0.000) and BW (p = 0.000). Thus, maternal and neonatal complications affect coagulation parameters in preterm and term neonates.

Risk factors and treatments for disseminated intravascular coagulation in neonates

“…Suzuki et al showed that plasma levels of thrombin-antithrombin complexes, D-dimer, fibrinogen, and fibrin degradation products in cord blood are higher in infants with birth asphyxia [19]. We previously described that maternal and neonatal complications such as birth asphyxia and PA affect coagulation parameters in preterm and term neonates [8]. In adults, most underlying conditions of DIC are reported to be infectious diseases, malignancies, trauma, and brain injury [1,20,21], while, we sometimes experience neonatal DIC with sepsis and necrotizing enterocolitis after birth; however, there were few cases of sepsisassociated neonatal DIC just after birth in the current study.…”

“…Of the 985 neonates admitted to our NICU between January 2010 and December 2017, 609 consecutive neonates born at 22-41 weeks were assessed for coagulation factors within the first 12 h of life, as previously described [8]. Of these, 366 neonates had at least one of underlying conditions and the remaining 243 neonates did not.…”

“…Our third limitation is that we used several treatments for DIC. Since our previous study reported that AT levels in premature infants were almost 28% [8], we often used AT supplementation for neonatal DIC along with rTM and FFP treatments. Many studies reported the efficacy of AT supplementation in adult patients with sepsis-associated DIC [28,29].…”

“…Samples for coagulation testing, routinely drawn on the first day of life, usually within 12 h of birth, were non-heparinized peripheral venous or peripheral arterial blood as previously described [8]. Coagulation tests were performed using a Sysmex CS-5100 coagulation analyzer (Sysmex, Kobe, Japan).…”

“…The Japan Society of Obstetrical, Gynecological & Neonatal Hematology (JSOGNH) recommends rTM administration for the treatment of DIC in neonates, and revised its diagnostic guidelines for neonatal DIC in 2016 [7]. We also reported gestational age (GA) and birth weight (BW) to be related to coagulation parameters [8]. Therefore, it is important to measure coagulation parameters in ill neonates with perinatal risk factors for DIC at birth and diagnose DIC in neonates.…”