Complications of haemophilia in babies (first two years of life): a report from the Centers for Disease Control and Prevention Universal Data Collection System.
OBJECTIVE
To describe the prevalence and complications in babies ≤2 years with haemophilia.


METHODS
We used a standardized collection tool to obtain consented data on eligible babies aged ≤2 years with haemophilia enrolled in the Centers for Disease Control and Prevention Universal Data Collection System surveillance project at US Hemophilia Treatment Centers (HTCs).


RESULTS
Of 547 babies, 82% had haemophilia A, and 70% were diagnosed within one month of birth. Diagnosis was prompted by known maternal carrier status (40%), positive family history (23%), bleeding (35%) and unknown 2%; 81% bled during the first two years. The most common events were bleeding (circumcision, soft tissue, oral bleeding) and head injury. There were 46 episodes of intracranial haemorrhage (ICH) in 37 babies (7%): 18 spontaneous, 14 delivery related, 11 traumatic, 2 procedure related and 1 unknown cause. Of the 176 central venous access devices (CVADs) in 148 (27%) babies, there were 137 ports, 22 surgically inserted central catheters and 20 peripherally inserted central catheters. Ports had the lowest complication rates. Inhibitors occurred in 109 (20%) babies who experienced higher rates of ICH (14% vs. 5%; P = 0.002), CVAD placement (61% vs. 19%; P < 0.001) and CVAD complications (44% vs. 26%; P < 0.001). The most common replacement therapy was recombinant clotting factor concentrates.


CONCLUSIONS
Bleeding events in haemophilic babies ≤2 years were common; no detectable difference in the rates of ICH by the mode of delivery was noted. Neonatal factor exposure did not affect the inhibitor rates. Minor head trauma, soft tissue and oropharyngeal bleeding were the leading indications for treatment.
Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI, USA.
R
R
Kulkarni
Division of Blood Disorders Centers for Disease Control and Prevention, Atlanta, GA, USA.
R J
RJ
Presley
Department of Pediatric Hematology, Children's Hospital of Michigan Wayne State Medical Center, Detroit, MI, USA.
J M
JM
Lusher
Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, USA.
A D
AD
Shapiro
Comprehensive Center for Bleeding Disorders, Blood Center of Wisconsin, Milwaukee, WI, USA.
J C
JC
Gill
Department of Pediatrics, University of Colorado, Aurora, CO, USA.
M
M
Manco-Johnson
UCSF Medical Center, San Francisco, CA, USA.
M A
MA
Koerper
Blood Center of Wisconsin, Milwaukee, WI, USA.
T C
TC
Abshire
Division of Blood Diseases and Resources, Bethesda, MD, USA.
D
D
DiMichele
National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
W K
WK
Hoots
Department of Pediatric Hematology/Oncology, University of New Mexico, Albuquerque, NM, USA.
P
P
Mathew
Center for Inherited Blood Disorders, Children's Hospital of Orange County, Orange, CA, USA.
D J
DJ
Nugent
University of Colorado Denver, Aurora, CO, USA.
S
S
Geraghty
Division of Blood Disorders Centers for Disease Control and Prevention, Atlanta, GA, USA.
B L
BL
Evatt
Division of Blood Disorders Centers for Disease Control and Prevention, Atlanta, GA, USA.
J M
JM
Soucie
D002487:Centers for Disease Control and Prevention, U.S.; D002675:Child, Preschool; D003625:Data Collection; D005260:Female; D006467:Hemophilia A / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D014481:United States
babies; central venous access device; haemophilia; head trauma; inhibitors; intracranial hemorrhage