title: Fresh frozen plasma transfusion - a risk factor for pulmonary hemorrhage in extremely low birth weight infants?
abstract: OBJECTIVE
  To evaluate risk factors for pulmonary hemorrhage (PH) in extremely low birth weight infants (ELBW) taking into consideration coagulation screens, platelet counts, transfusion of fresh frozen plasma (FFP), and platelet concentrates prior to PH.
  
  
  METHODS
  A retrospective case-control study consisting of 20 ELBW infants with PH and 40 matched controls. Coagulation screens, platelet counts at birth and at onset of PH, and transfusion frequencies prior to PH were compared to case-controls at birth and 24-96 h after birth.
  
  
  RESULTS
  While the initial platelet counts, fibrinogen concentrations, and international normalized ratios were similar in PH infants and controls, the activated partial prothrombin time was prolonged (P=0.05). Compared to 28% of case controls (P<0.05), 55% of infants with later PH received FFP prior to PH. Platelet counts were significantly lower at onset of PH (median 81/nL; range: 37-236/nL) compared to controls (166/nL; 27-460/nL; P<0.005). Multivariate analysis indicated a lack of antenatal steroids, supplemental oxygen, and transfusion of FFP as independent risk factors for PH.
  
  
  CONCLUSIONS
  Prolonged activated partial thromboplastin time (aPTT) might be associated with PH. PH does not primarily depend upon severe thrombocytopenia. A developmental mismatch in hemostasis by transfusion of adult donor plasma should be considered a risk factor for PH.
authors.affiliation: .
authors.forename: Jakob
authors.initials: J
authors.lastname: Usemann
authors.affiliation: .
authors.forename: Lars
authors.initials: L
authors.lastname: Garten
authors.affiliation: .
authors.forename: Christoph
authors.initials: C
authors.lastname: Bührer
authors.affiliation: .
authors.forename: Christof
authors.initials: C
authors.lastname: Dame
authors.affiliation: .
authors.forename: Malte
authors.initials: M
authors.lastname: Cremer
mesh_terms: D005858:Germany / Q000453:epidemiology; D006470:Hemorrhage / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D008171:Lung Diseases / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D010949:Plasma; D012189:Retrospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction / Q000150:complications*
keywords: Bleeding; coagulation disorder; extremely low birth weight; fresh frozen plasma; platelet transfusion; thrombocytopenia