title: Cellular and humoral coagulation profiles and occurrence of IVH in VLBW and ELWB infants.
abstract: OBJECTIVE
  Intraventricular hemorrhage (IVH) is a major complication in preterm neonates with significant long-term morbidity and an increased mortality rate. The role of the immature coagulation system in the pathogenesis of IVH in these infants is still under debate. The aim of this study was to provide reference values for coagulation studies within the first 24h of life, and to relate these findings to the incidence of IVH.
  
  
  METHODS
  In this retrospective study, a total of 250 (male: 123/female: 127; VLBW: 150 and ELBW: 100) infants were included over a 4-year-period. Coagulation studies were performed within the first 24h of life in all infants. Multiple regression analysis was employed to demonstrate a potential association between IVH and a number of known risk and protective factors for IVH (antenatal steroids, birth weight, gender, IUGR, APGAR score at 10minutes, platelet count, INR, PTT, fibrinogen).
  
  
  RESULTS
  Mean birth weight was 1047.9±305.6 (range: 320-1490g). Both cellular (platelets, nucleated red blood cells) and plasmatic coagulation parameters (INR, fibrinogen and antithrombin III) were dependent on birth weight. Moreover, INR levels (p<0.05) were significantly increased in neonates with IVH of any grade. Also, INR was positively correlated with the severity of IVH (Spearman's correlation coefficient: 0.193; p=0.003). While overall fibrinogen levels were not associated with IVH, a fibrinogen level<100mg/dL significantly increased the risk for IVH (p<0.01).
  
  
  CONCLUSIONS
  Our data provide a robust set of reference values for both cellular and humoral coagulation studies in VLBW and ELBW infants for the first 24h of life. The results of our study indicate that abnormal INR levels and fibrinogen levels<100mg/dL are significantly associated with the occurrence of IVH in this susceptible cohort.
authors.affiliation: University Hospital of Saarland, Medical School, Germany.
authors.forename: Perrine
authors.initials: P
authors.lastname: Duppré
authors.affiliation: University Children's Hospital of Saarland, Department of Pediatric Cardiology, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Sauer
authors.affiliation: University Children's Hospital of Saarland, Department of Pediatrics and Neonatology, Germany.
authors.forename: Eleni Z
authors.initials: EZ
authors.lastname: Giannopoulou
authors.affiliation: University Hospital of Saarland, Medical School, Germany; University Children's Hospital of Saarland, Department of Pediatrics and Neonatology, Germany.
authors.forename: Ludwig
authors.initials: L
authors.lastname: Gortner
authors.affiliation: University Children's Hospital of Saarland, Department of Pediatrics, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Nunold
authors.affiliation: University Hospital of Saarland, Institute of Medical Biometry, Epidemiology, and Medical Informatics, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wagenpfeil
authors.affiliation: University Hospital of Saarland, Clinical Chemistry and Laboratory Diagnostics, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Geisel
authors.affiliation: University Hospital of Saarland, Department of Clinical Hemostaseology, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Stephan
authors.affiliation: University Hospital of Saarland, Medical School, Germany; University Children's Hospital of Saarland, Department of Pediatrics and Neonatology, Germany. Electronic address: sascha.meyer@uks.eu.
authors.forename: Sascha
authors.initials: S
authors.lastname: Meyer
mesh_terms: D000990:Antithrombin III / Q000032:analysis; D001777:Blood Coagulation / Q000502:physiology*; D002543:Cerebral Hemorrhage / Q000097:blood / Q000453:epidemiology*; D004906:Erythrocyte Count; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D015994:Incidence; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood / Q000453:epidemiology*; D019102:Infant, Very Low Birth Weight; D019934:International Normalized Ratio; D008297:Male; D010976:Platelet Count; D012189:Retrospective Studies
chemical_list: D000990:Antithrombin III; D005340:Fibrinogen
keywords: Coagulation; ELWB infants; Intraventricular hemorrhage; VLBW infants