title: Neonatal bleeding in haemophilia: a European cohort study.
abstract: Birth is the first haemostatic challenge for a child with haemophilia. Our aim was to examine the association between perinatal risk factors and major neonatal bleeding in infants with haemophilia. This observational cohort study in 12 European haemophilia treatment centres (HTC) incorporated 508 children with haemophilia A or B, born between 1990 and 2008. Risk factors for bleeding were analysed by univariate analysis. Head bleeds occurred in 18 (3·5%) children within the first 28 d of life, including three intraparenchymal bleeds, one subdural haematoma and 14 cephalohaematomas. Intra-cranial bleeds were associated with long-term neurological sequelae in two (0·4%) cases; no deaths occurred. Assisted delivery (forceps/vacuum) was the only risk factor for neonatal head bleeding [Odds Ratio (OR) 8·84: 95% confidence interval (CI) 3·05-25·61]. Mild haemophilia and maternal awareness of her haemophilia carrier status seemed to be protective (OR 0·24; 95%CI 0·05-1·05 and OR 0·34; 95%CI 0·10-1·21, respectively), but due to the low number of events this was not statistically significant. We found no association between neonatal head bleeding and country, maternal age, parity, gestational age or presence of HTC. Maternal awareness of carrier status protected against assisted delivery (unadjusted OR 0·37; 95%CI 0·15-0·90; adjusted OR 0·47 (95%CI 0·18-1·21).
authors.affiliation: Paediatric Haematology Department; Leeds General Infirmary, Leeds, UK. Michael.richards@leedsth.nhs.uk
authors.forename: M
authors.initials: M
authors.lastname: Richards
authors.forename: G
authors.initials: G
authors.lastname: Lavigne Lissalde
authors.forename: C
authors.initials: C
authors.lastname: Combescure
authors.forename: A
authors.initials: A
authors.lastname: Batorova
authors.forename: G
authors.initials: G
authors.lastname: Dolan
authors.forename: K
authors.initials: K
authors.lastname: Fischer
authors.forename: R
authors.initials: R
authors.lastname: Klamroth
authors.forename: T
authors.initials: T
authors.lastname: Lambert
authors.forename: M
authors.initials: M
authors.lastname: Lopez-Fernandez
authors.forename: R
authors.initials: R
authors.lastname: Pérez
authors.forename: A
authors.initials: A
authors.lastname: Rocino
authors.forename: K
authors.initials: K
authors.lastname: Fijnvandraat
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000150:complications; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005164:Factor IX / Q000627:therapeutic use; D005169:Factor VIII / Q000627:therapeutic use; D005260:Female; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology; D006467:Hemophilia A / Q000150:complications*; D002836:Hemophilia B / Q000150:complications*; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006782:Hospitals, Special; D006801:Humans; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000209:etiology; D008297:Male; D018743:Perinatal Care; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000523:psychology; D012307:Risk Factors; D055815:Young Adult
chemical_list: D005169:Factor VIII; D005164:Factor IX