Heparin and the risk of intraventricular hemorrhage in premature infants.
OBJECTIVE
This study was carried out to determine whether the routine use of low-dose heparin in umbilical catheter infusates increases the risk of intraventricular hemorrhage or alters the coagulation profile in premature infants.


METHODS
In a randomized, blinded trial, 113 infants born at less than 31 weeks' gestation were assigned to receive, in their umbilical catheter infusate, either 1 unit of heparin per milliliter (n = 55) or no heparin (n = 58). Prothrombin time, activated partial thromboplastin time, fibrinogen concentration, and antithrombin III activity levels were determined at the start and the completion of the study. Cranial ultrasonography was performed during the first week of life.


RESULTS
There was no difference in the incidence of intraventricular hemorrhage between the heparin and no heparin groups, 35.8% and 31.5%, respectively (p = 0.6). Similarly, no difference was detected in the incidence of severe intraventricular hemorrhage (grades III/IV). Prothrombin time, activated partial thromboplastin time, and fibrinogen levels were not significantly different between the two groups. However, the use of heparin was associated with a lower antithrombin III activity level. Antenatal indomethacin use was associated with a 2.9 increased risk of intraventricular hemorrhage (95% confidence interval, 1.15 to 7.17).


CONCLUSIONS
A low dose of heparin added to umbilical catheter infusates does not increase the incidence or severity of intraventricular hemorrhage or significantly alter the coagulation profile in premature infants.
Chang
G Y
GY
Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois, USA.
Lueder
F L
FL
DiMichele
D M
DM
Radkowski
M A
MA
McWilliams
L J
LJ
Jansen
R D
RD
D000925:Anticoagulants / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D002408:Catheters, Indwelling; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging; D002552:Cerebral Ventricles; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D007262:Infusions, Intravenous; D008297:Male; D012307:Risk Factors; D016037:Single-Blind Method; D017585:Ultrasonography, Doppler, Transcranial; D014469:Umbilical Arteries
D000925:Anticoagulants; D006493:Heparin