Abstract:Context:There are limited studies assessing the neonatal hemostatic factors in relation to birth weight.Aims:This study aims to compare the coagulation factors between three groups of neonates with different birth weight for gestational age (GA).Settings and Design:In a cross-sectional study, 74 healthy premature neonates were involved.Subjects and Methods:Serum prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), thrombin clotting time (TT), and levels of … Show more
“…However, Perlman and Dvilansky 64 found no difference in levels of factors V and VIII. Plasma concentrations of inhibitors of coagulation, such as protein S and antithrombin, were lower in FGR infants, although one study reported high levels of protein C. 14,71,75 Increased levels of tPA 14,70 and lower plasma fibrinogen were also reported, 13,65,68,70 although these observations were not confirmed in other studies. 64,69 No difference in plasminogen levels is usually noted; 69 however, one paper claimed a decrease in plasminogen levels in IUGR term neonates, especially when complications in the perinatal period occurred.…”
Section: Discussionmentioning
confidence: 92%
“…13 As stated above, liver is one of the first organs affected by chronic hypoxia and as such the production of proteins, such as clotting factors, could be reduced. As for standard coagulation tests, PT, APTT and INR are usually prolonged, 11,14,64,65,68,71 although some studies detected no difference in these parameters in SGA vs AGA infants. 66,72 Among the few studies that investigated vitamin K-dependent coagulation factors II and X, they were not altered by growth restriction.…”
Section: Discussionmentioning
confidence: 99%
“…A possible explanation is that the studied population is diverse and that confounding factors affecting coagulation exist. 69,71 Time of blood collection, administration of vitamin K, gestational age of the neonate, presence of comorbidities such as sepsis or birth asphyxia and mode of delivery vary considerably; as a result, the interpretation of results should be carefully considered. Standard coagulation tests are used in everyday practice for the evaluation of coagulopathy and the need for fresh frozen plasma transfusion, 13 although their capacity to reflect the hemostatic system as a whole and their ability to correlate with hemorrhagic manifestations is limited.…”
Section: Discussionmentioning
confidence: 99%
“…Abdollahi et al, 71 using cord blood samples, assessed hemostatic parameters in preterm infants before the administration of vitamin K. Besides lower platelet count, APTT was prolonged in SGA neonates compared with AGA and LGA groups. For inhibitors of coagulation, protein S levels were reduced, while protein C was elevated.…”
Intrauterine growth restriction (IUGR) affects nearly 10 to 15% of pregnancies and is responsible for many short- and long-term adverse consequences, including hemostatic derangement. Both thrombotic and hemorrhagic events are described in the perinatal period in these neonates. The aim of this study was to systematically review the literature on the laboratory studies used to evaluate the hemostatic system of the IUGR small for gestational age neonate. We reviewed the current literature via PubMed and Scopus until September 2022. Following our inclusion/exclusion criteria, we finally included 60 studies in our review. Thrombocytopenia, characterized as hyporegenerative and a kinetic upshot of reduced platelet production due to in utero chronic hypoxia, was the main finding of most studies focusing on growth-restricted neonates, in most cases is mild and usually resolves spontaneously with the first 2 weeks of life. In regard to coagulation, growth-restricted newborns present with prolonged standard coagulation tests. Data regarding coagulation factors, fibrinolytic system, and anticoagulant proteins are scarce and conflicting, mainly due to confounding factors. As thromboelastography/rotational thromboelastometry (TEG/ROTEM) provides a more precise evaluation of the in vivo coagulation process compared with standard coagulation tests, its use in transfusion guidance is fundamental. Only one study regarding TEG/ROTEM was retrieved from this population, where no difference in ROTEM parameters compared with appropriate for gestational age neonates was found. Despite the laboratory aberrations, no correlation could be achieved with clinical manifestations of bleeding or thrombosis in the studies included. More studies are needed to assess hemostasis in IUGR neonates and guide targeted therapeutic interventions.
“…However, Perlman and Dvilansky 64 found no difference in levels of factors V and VIII. Plasma concentrations of inhibitors of coagulation, such as protein S and antithrombin, were lower in FGR infants, although one study reported high levels of protein C. 14,71,75 Increased levels of tPA 14,70 and lower plasma fibrinogen were also reported, 13,65,68,70 although these observations were not confirmed in other studies. 64,69 No difference in plasminogen levels is usually noted; 69 however, one paper claimed a decrease in plasminogen levels in IUGR term neonates, especially when complications in the perinatal period occurred.…”
Section: Discussionmentioning
confidence: 92%
“…13 As stated above, liver is one of the first organs affected by chronic hypoxia and as such the production of proteins, such as clotting factors, could be reduced. As for standard coagulation tests, PT, APTT and INR are usually prolonged, 11,14,64,65,68,71 although some studies detected no difference in these parameters in SGA vs AGA infants. 66,72 Among the few studies that investigated vitamin K-dependent coagulation factors II and X, they were not altered by growth restriction.…”
Section: Discussionmentioning
confidence: 99%
“…A possible explanation is that the studied population is diverse and that confounding factors affecting coagulation exist. 69,71 Time of blood collection, administration of vitamin K, gestational age of the neonate, presence of comorbidities such as sepsis or birth asphyxia and mode of delivery vary considerably; as a result, the interpretation of results should be carefully considered. Standard coagulation tests are used in everyday practice for the evaluation of coagulopathy and the need for fresh frozen plasma transfusion, 13 although their capacity to reflect the hemostatic system as a whole and their ability to correlate with hemorrhagic manifestations is limited.…”
Section: Discussionmentioning
confidence: 99%
“…Abdollahi et al, 71 using cord blood samples, assessed hemostatic parameters in preterm infants before the administration of vitamin K. Besides lower platelet count, APTT was prolonged in SGA neonates compared with AGA and LGA groups. For inhibitors of coagulation, protein S levels were reduced, while protein C was elevated.…”
Intrauterine growth restriction (IUGR) affects nearly 10 to 15% of pregnancies and is responsible for many short- and long-term adverse consequences, including hemostatic derangement. Both thrombotic and hemorrhagic events are described in the perinatal period in these neonates. The aim of this study was to systematically review the literature on the laboratory studies used to evaluate the hemostatic system of the IUGR small for gestational age neonate. We reviewed the current literature via PubMed and Scopus until September 2022. Following our inclusion/exclusion criteria, we finally included 60 studies in our review. Thrombocytopenia, characterized as hyporegenerative and a kinetic upshot of reduced platelet production due to in utero chronic hypoxia, was the main finding of most studies focusing on growth-restricted neonates, in most cases is mild and usually resolves spontaneously with the first 2 weeks of life. In regard to coagulation, growth-restricted newborns present with prolonged standard coagulation tests. Data regarding coagulation factors, fibrinolytic system, and anticoagulant proteins are scarce and conflicting, mainly due to confounding factors. As thromboelastography/rotational thromboelastometry (TEG/ROTEM) provides a more precise evaluation of the in vivo coagulation process compared with standard coagulation tests, its use in transfusion guidance is fundamental. Only one study regarding TEG/ROTEM was retrieved from this population, where no difference in ROTEM parameters compared with appropriate for gestational age neonates was found. Despite the laboratory aberrations, no correlation could be achieved with clinical manifestations of bleeding or thrombosis in the studies included. More studies are needed to assess hemostasis in IUGR neonates and guide targeted therapeutic interventions.
“…Hal ini sejalan dengan penelitian sebelumnya oleh Salonvaara dkk 9 yang mendeteksi penurunan pada faktor V dan faktor VII pada bayi KMK dibandingkan SMK. Abdollahi dkk 19 Salonvaara dkk 9 melaporkan bahwa bayi asfiksia dengan skor APGAR <7 pada menit ke-5 mengalami pemanjangan studi koagulasi berupa faktor II, V, VII, X, dan pemanjangan prothrombin, sedangkan partial thomboplastin time tidak memanjang. Studi lain oleh Murthy dkk 22 melaporkan bahwa bayi dengan asfiksia berat (skor APGAR <7 pada menit ke-5) mengalami pemanjangan PTTK (pemanjangan jika nilai lebih besar dari kontrol).…”
Latar belakang. Perdarahan pada neonatus merupakan 10% penyebab kematian di NICU. Deteksi awal perdarahan sering terlambat sebab tidak semua neonatus dengan pemanjangan faktor koagulasi bermanifestasi perdarahan. Diperlukan tindakan deteksi dini pada neonatus dengan faktor risiko penyakit perdarahan (skrining prothrombin time (PT) dan partial thromboplastin time with kaolin (PTTK)). Tujuan. Meneliti faktor maternal dan neonatal terhadap gangguan koagulasi pada neonatus. Metode. Studi kasus kontrol dengan 45 subjek pada kelompok kasus dengan pemanjangan studi koagulasi (PT dan PTTK) dan 45 subjek pada kelompok kontrol dengan studi koagulasi normal di RSUP Dr. Kariadi Semarang dan RS Telogorejo (Semarang Medical Centre) antara tahun 2016-2017. Faktor risiko didapat dari anamnesis dan data rekam medik. Analisis data menggunakan chi square lanjut analisis multivariat regresi logistik ganda (Backward Wald).Hasil. Preeklampsia (RO 4,26; p=0,018) dan Kecil Masa Kehamilan (KMK) (RO 4,52; p=0,042) adalah faktor risiko signifikan terhadap pemanjangan PT dan PTTK neonatus. Faktor risiko maternal dan neonatal lain yaitu korioamnionitis, obat dikonsumsi ibu (antikoagulan /antikonvulsan), Bayi Kurang Bulan, asfiksia, sepsis, penyakit hati tidak terbukti sebagai faktor risiko pemanjangan PT dan PTTK. Kesimpulan. Preeklampsia dan KMK merupakan faktor risiko signifikan secara statistik terhadap pemanjangan PT dan PTTK pada neonatus. Preeklampsia adalah faktor risiko paling kuat berpengaruh terhadap pemanjangan PT dan PTTK pada neonatus.
Although the hemostatic potential of adult platelets has been investigated extensively, regulation of platelet function during fetal life is less clear. Recent studies have provided increasing evidence for a developmental control of platelet function during fetal ontogeny. Fetal platelets feature distinct differences in reactive properties compared with adults. These differences very likely reflect a modified hemostatic and homeostatic environment in which platelet hyporeactivity contributes to prevent pathological clot formation on the one hand but still ensures sufficient hemostasis on the other hand. In this review, recent findings on the ontogeny of platelet function and reactivity are summarized, and implications for clinical practice are critically discussed. This includes current platelet-transfusion practice and its potential risk in premature infants and neonates.
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