Antithrombin III administration in neonates with congenital diaphragmatic hernia during the first three days of extracorporeal membrane oxygenation.
OBJECTIVE
To evaluate the effect of Antithrombin III (ATIII) on blood product requirement in neonates receiving extracorporeal membrane oxygenation (ECMO).


METHODS
A retrospective case control study of neonates presenting with or without congenital diaphragmatic hernia (CDH) requiring ECMO between 2006 and 2010 was performed. Patient demographics, laboratory data, and information on blood products administered were compared in patients treated before (n=37) and after (n=38) a protocol for antithrombin-III (ATIII) administration was implemented.


RESULTS
During the first three days on ECMO patients with CDH received less fresh frozen plasma (FFP) and platelets after ATIII administration was introduced (78.1 ± 19.2 ml/kg vs. 27.8 ± 6.2 ml/kg, p<0.007 and 67.8 ± 8.6 ml/kg vs. 47.8 ± 8.4 ml/kg, p=0.05 respectively), while FFP and platelet administration in patients without CDH was not different between the two periods. Patients both with and without CDH received less packed red blood cell (PRBC) transfusions after the ATIII protocol was introduced (230 ± 51.5 ml/kg vs. 73.8 ± 9.7 ml/kg, p<0.002 and 173.2 ± 22.2 ml/kg vs. 66.0 ± 6.6 ml/kg, p<0.001, respectively). Finally, cryoprecipitate administered was not different in patients with and without CDH between the two periods (13 ± 2.9 ml/kg vs. 15.9 ± 7.2 ml/kg, p=NS and 6.1 ± 1.8 ml/kg vs. 3.4 ± 0.6 ml/kg, p=NS, respectively).


CONCLUSIONS
Introduction of routine ATIII administration was associated with decreases in FFP, platelet, and PRBC exposure in neonates with CDH and decreases in PRBC transfusions in neonates without CDH during the first three days of ECMO support.
Center for Fetal and Neonatal Medicine, USC Division of Neonatal Medicine, Children's Hospital Los Angeles and LAC+USC Medical Center Los Angeles, CA, 90027, USA.
Rebecca
R
Perry
James
J
Stein
Guy
G
Young
Rangasamy
R
Ramanathan
Istvan
I
Seri
Laura
L
Klee
Philippe
P
Friedlich
D000990:Antithrombin III; D019559:Capillary Leak Syndrome / Q000209:etiology; D016022:Case-Control Studies; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005169:Factor VIII / Q000627:therapeutic use; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use; D019983:Guideline Adherence; D006548:Hernia, Diaphragmatic / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation / Q000097:blood / Q000209:etiology; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000517:prevention & control; D008297:Male; D010949:Plasma; D017713:Platelet Transfusion / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
C026912:cryoprecipitate coagulum; D000990:Antithrombin III; D005169:Factor VIII; D005340:Fibrinogen
ATIII; Antithrombin III; Blood product; Congenital diaphragmatic hernia; ECMO; Extracorporeal membrane oxygenation; Neonate