Role of Coagulopathy in Newborn Intracranial Hemorrhage

Abstract

Fifty newborn infants of less than 33 weeks' gestation were followed prospectively from birth with serial coagulation and real-time ultrasound studies. A significant association of hypocoagulability in the first four hours of life with subsequent onset or progression of intraventricular or other clinical hemorrhages was documented. Abnormalities included lower values for fibrinogen, platelet count, antithrombin III, and factor VIII with higher values for fibrin monomer and longer Laidlaw whole blood clotting times. These abnormalities tended to correct spontaneously in surviving infants. An association between gestational complications and incidence of hypocoagulability and intracranial hemorrhage (ICH) was noted. Babies of preeclamptic mothers had fewer abnormalities and babies born to mothers with premature rupture of membranes and suspected amnionitis manifested more hypocoagulability and more severe intracranial hemorrhages.

The Role of Platelets in Premature Neonates with Intraventricular Hemorrhage: A Systematic Review and Meta-Analysis

“…Exclusion of 68 records resulted in 30 studies being included in this review. 9 10 11 13 14 15 16 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 A summary of the included studies is given in Table 1 .…”

“…Data for the meta-analysis could be extracted from 10 studies measuring platelet count 10 13 14 16 25 27 31 35 38 40 and 7 studies evaluating MPV. 10 13 14 16 25 27 40 Of the 20 studies excluded from the meta-analysis, 4 did not investigate platelet count or MPV at day 1 of life, 9 23 26 30 5 did not report the time of blood sampling, 28 29 32 37 41 in 7 studies it was not possible to obtain raw data or mean ± SD from the authors, 15 22 24 33 34 36 39 and, finally, 4 studies did not compare neonates with and without IVH. 11 20 21 42…”

“…►Table 2 shows the nine studies presenting platelet count as a categorically variable. 15,22,28,32,33,36,39,41,42 Among the five studies 15,28,36,39,41 evaluating neonates with the lowest platelet count < 150 Â 10 9 /L measured within the first week of life, two studies indicated an increased risk of IVH. 15,39 Four 22,32,33,42 of five 22,32,33,36,42 studies evaluating platelet counts < 100 Â 10 9 /L observed increased IVH risk.…”

“…15,22,28,32,33,36,39,41,42 Among the five studies 15,28,36,39,41 evaluating neonates with the lowest platelet count < 150 Â 10 9 /L measured within the first week of life, two studies indicated an increased risk of IVH. 15,39 Four 22,32,33,42 of five 22,32,33,36,42 studies evaluating platelet counts < 100 Â 10 9 /L observed increased IVH risk. Both studies examining neonates with platelet counts < 50 Â 10 9 /L found an increased incidence of IVH in this group.…”

“…10,11,23,25,35,37,40 However, McDonald et al demonstrated significantly higher incidence of IVH in neonates with < 150 mg/dL fibrinogen. 39 Thromboelastography was performed in two studies. 23,30 Strauss et al observed increased clotting time and decreased clot firmness in one neonate with IVH, 30 whereas Radicioni et al did not find differences in any thromboelastography parameters in neonates with and without IVH.…”