Mode of delivery and cranial bleeding in newborns with haemophilia: a systematic review and meta‐analysis of the literature

Davies, J.; Kadir, Rezan A.

doi:10.1111/hae.12726

Cited by 46 publications

(51 citation statements)

References 43 publications

(82 reference statements)

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“…The circumstances surrounding the delivery, whether some of the CS deliveries were unplanned and occurred following the onset of labour, were not known. Davies and Kadir [11] performed a meta-analysis of observational cohort studies and prospective imaging studies and reported that newborns with haemophilia were 44 times more likely to experience symptomatic ICH compared to the general population and the odds ratio of experiencing ICH were 4.4 (95% CI: 1.46–13.7, P = 0.008) following an assisted vaginal delivery and 0.34 (95% CI: 0.14–0.83, P = 0.018) following CS compared to vaginal delivery. This has implications especially in pregnant carriers where the avoidance of assisted deliveries is crucial.…”

Section: Discussionmentioning

confidence: 99%

Complications of haemophilia in babies (first two years of life): a report from the Centers for Disease Control and Prevention Universal Data Collection System

et al. 2016

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Aim 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. Conclusion 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.

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Section: Discussionmentioning

confidence: 99%

Complications of haemophilia in babies (first two years of life): a report from the Centers for Disease Control and Prevention Universal Data Collection System

et al. 2016

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“…Intracranial haemorrhage has been estimated to occur in 3%‐4% of neonates with haemophilia and has been associated with trauma at delivery, leading to debate on the optimal mode of delivery . The incidence of ICH in older children with haemophilia has been estimated previously at 2.02‐7.96 per 1000 patient years, but is less well defined in the modern era where, at least in the developed world, prophylaxis commenced early in childhood is widespread and may offer protection against all types of bleeding .…”

Section: Introductionmentioning

confidence: 99%

Intracranial haemorrhage in children with inherited bleeding disorders in the UK 2003‐2015: A national cohort study

et al. 2018

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“…Approximately 11% of obstetricians in a US survey preferred C/S over vaginal delivery in carriers. 24 Cranial ultrasounds should be performed in severe haemophilia especially for traumatic delivery. 22,23 Davis and Kadir reported that haemophilic neonates were 44-times more likely to experience ICH compared to the general population.…”

Section: Birth/neonatementioning

confidence: 99%

Optimizing bleed prevention throughout the lifespan: Womb to Tomb

Gupta

Shapiro

2018

Haemophilia

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The focus of care providers, patients and families is the ability to tailor care for persons with haemophilia (PWH) across the lifespan. Care requires knowledge of the bleeding disorder and age-related complications, risk of therapeutic interventions, and evaluation of individual characteristics that contribute to outcomes. The ultimate goal is to live a normal life without the burden of bleeding, for PWH and carriers. A wide range of therapeutic options is required to achieve personalized care. Over the last decade, substantial therapeutic advantages have been achieved in the treatment of haemophilia that include the development of a robust array of factor concentrates, novel haemostatic agents, and increased knowledge and awareness of disease associated outcomes and risk factors. Significant strides on the road to accessible gene therapy have been realized. This increased range of therapeutic modalities provides options for development and implementation of care plans for each patient at each stage of life that are more flexible compared to prior care regimens. Paradigms for management of haemophilia are changing. As a community, we must work together to use these resources wisely, to learn from outcomes with new therapies and diagnostic tools, to assure all patients can achieve improved care and outcomes regardless of disease state or country of origin.

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Mode of delivery and cranial bleeding in newborns with haemophilia: a systematic review and meta‐analysis of the literature

Abstract: Cranial bleeding occurs with a significantly higher frequency in newborns with haemophilia compared to the general population. In newborns with haemophilia, delivery by a CS is associated with the lowest risk of ICH. AVD significantly increases the risk of ICH and should be avoided.

Cited by 46 publications

References 43 publications

Complications of haemophilia in babies (first two years of life): a report from the Centers for Disease Control and Prevention Universal Data Collection System

Complications of haemophilia in babies (first two years of life): a report from the Centers for Disease Control and Prevention Universal Data Collection System

Intracranial haemorrhage in children with inherited bleeding disorders in the UK 2003‐2015: A national cohort study

Optimizing bleed prevention throughout the lifespan: Womb to Tomb

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