Shorter PFA‐100® closure times in neonates than in adults: role of red cells, white cells, platelets and von Willebrand factor

Roschitz, B.; Sudi, Karl; Köstenberger, M.; Muntean, W.

doi:10.1111/j.1651-2227.2001.tb02431.x

Cited by 89 publications

(39 citation statements)

References 27 publications

(43 reference statements)

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“…We speculate that the anti-platelet effect of ampicillin explains, at least in part, the discrepancy between relatively short PFA-100 times reported from umbilical cord blood and the longer times reported from NICU patients during the first days after birth. 16,18 On the basis of our present studies, and similar findings in adults, we conclude that ampicillin administered to neonates can indeed moderately prolong their bleeding time. However, any clinically significant bleeding tendency conveyed to NICU patients by ampicillin requires much more definition.…”

Section: Discussionsupporting

confidence: 66%

Effect of ampicillin on the bleeding time of neonatal intensive care unit patients

et al. 2009

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Objective: Studies in adults indicate that ampicillin, in a dose-dependent manner, impairs platelet function and moderately prolongs the bleeding time (generally by 60 to 90 s). Unlike aspirin, the inhibition induced by ampicillin involves both reversible and irreversible mechanisms and is not observed immediately after initial dosing (generally requiring approximately 24 h). Ampicillin is administered commonly to neonatal intensive care unit (NICU) patients, but its effect on bleeding time in this population has not been reported earlier.Study Design: We performed neonatal template bleeding times and platelet function analyzer (PFA)-100 tests on 15 NICU patients before and at various intervals after intravenous ampicillin dosing.Result: Neonates were only studied if no beta-lactam antibiotics were administered to their mother during labor, and if they had ampicillin ordered by the clinician at a dose of 50 to 100 mg kg -1 every 12 h. Subjects ranged from 33 to 41 weeks gestation and weighed 1760 to 3835 g. Bleeding times before the first ampicillin dose (n ¼ 15) averaged 134 s (95% confidence interval (CI), 120 to 148 s) and PFA-100 times averaged 123 s (95% CI, 96 to 149 s). After the first dose of ampicillin (n ¼ 5), bleeding times and PFA-100 times did not increase, but after the third (n ¼ 5) and fourth doses (n ¼ 4) bleeding times lengthened by an average of 60 s (95% CI, 37 to 83 s, P<0.001) and PFA-100 times lengthened by an average of 20 s (95% CI, À20 to 60 s, P ¼ 0.15).Conclusion: Ampicillin administered intravenously to NICU patients prolongs the bleeding time, with a magnitude-of-effect and time-to-effect similar to that shown earlier in adults.

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Section: Discussionsupporting

confidence: 66%

Effect of ampicillin on the bleeding time of neonatal intensive care unit patients

et al. 2009

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“…15,16 In fact, the PFA-100 times we measured were generally longer than those found in umbilical cord blood. [23][24][25] PFA closure times measured using umbilical cord blood are generally shorter than those measured from adult blood. [23][24][25] .We speculate that platelet dysfunction can be induced during the first days of NICU care by medications such as ampicillin given in high doses (100 mg kg À1 per dose).…”

Section: Discussionmentioning

confidence: 95%

“…[23][24][25] PFA closure times measured using umbilical cord blood are generally shorter than those measured from adult blood. [23][24][25] .We speculate that platelet dysfunction can be induced during the first days of NICU care by medications such as ampicillin given in high doses (100 mg kg À1 per dose). 26 That theory might explain the longer baseline PFA-100 times we found, compared with cord blood.…”

Section: Discussionmentioning

confidence: 95%

Ibuprofen lysine administration to neonates with a patent ductus arteriosus: effect on platelet plug formation assessed by in vivo and in vitro measurements

et al. 2008

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Objective: Ibuprofen might have advantages over indomethacin, when used to effectuate closure of a neonate's patent ductus arteriosus (PDA). Several previous studies indicate that platelet plug formation is impaired after administration of indomethacin, but it is not clear whether a similar impairment occurs following ibuprofen dosing.Study Design: We performed template bleeding times and PFA-100 tests (platelet function analyzer) on 20 neonates who had a PDA, before and again at various preset intervals following ibuprofen dosing.Result: Patients ranged from 23 to 40 weeks gestation and weighed 511 to 2566 g. Their first dose of ibuprofen was administered at 72 h (18 to 363 h) after birth (median, range). None of the subjects had clinical bleeding problems noted during the days they received ibuprofen dosing. The template bleeding times before dosing ranged from 135 to 450 s. Repeat tests were performed in groups of four, at 2 h, 4 to 6 h, 12 to 18 h, 24 h after the first dose, and at 2 h after the third dose of ibuprofen. No changes in bleeding times were detected. (P ¼ 0.299) A PFA-100 time was performed on all 20 patients before and again after the ibuprofen administration. However, 3 of the 40 tests were unsuccessful, because of microclots in the blood sample (n ¼ 1) or failure of the analyzer for an unspecified reason (n ¼ 2). Before the dosing the PFA-100 time ranged from 52 to 300 s. A paired t-test showed a slight but statistically significant lengthening in PFA-100 time after the ibuprofen administration (P ¼ 0.019). The correlation between the bleeding time and the PFA-100 was poor (R 2 ¼ 0.212, P ¼ 0.576). Conclusion:On the basis of our present studies, we speculate that ibuprofen lysine administration to neonates with a PDA, when used according to the manufacturer's recommendations, has little adverse effect on platelet plug formation. This information might be a factor to consider when deciding whether to select indomethacin or ibuprofen for PDA closure.

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“…We measured platelet function in two ways, template bleeding time [1][2][3][4][5] and PFA-100 time. [9][10][11][12][13] As was the case in our previous study of ampicillin dosing to late preterm and term neonates, 5 we hypothesized that a few doses of ampicillin would have little effect on platelet function, but that ampicillin treatment for the entire first week would prolong the bleeding time.…”

Section: Introductionmentioning

confidence: 93%

Effect of ampicillin on bleeding time in very low birth-weight neonates during the first week after birth

et al. 2011

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Objective: On the day of birth, the bleeding time of very low birth-weight (VLBW, <1500 g) neonates is generally prolonged, compared with term neonates. However, their bleeding time generally improves (shortens) over the next 7 to 10 days. Ampicillin can prolong the bleeding times of term and late preterm neonates, but its effect on VLBW neonates, who already have a somewhat prolonged bleeding time initially, is not known.Syudy Design: This was a prospective, single-centered, paired, before vs after test of the effect of ampicillin on template bleeding time and PFA-100 time (platelet function analyzer). Ampicillin was dosed at every 12 h intravenously, but decisions about discontinuation were made by the responsible clinician, independent of this study.Result: A total of 20 VLBW neonates were studied. They ranged from 23-to 30-weeks gestation at birth and weighed 500 to1410 g. Initial bleeding times averaged 166 s (95% CI, 138 to 194) and initial PFA-100 times averaged 119 s (95% CI, 90 to 148). In all, 10 had ampicillin dosing stopped after a shorter course (4 to 7 doses) and 10 had it continued for a longer course (10 to 15 doses). Blood cultures were sterile in all 20, and no differences in laboratory or clinical features were found between those treated with a shorter vs longer course. After stopping the ampicillin following a short course the bleeding times and PFA-100 times were similar to the initial values. However, after a longer course the bleeding times were prolonged by an average of 2 min, to 284 s (95% CI, 242 to 326; P ¼ 0.001 vs initial). The PFA-100 times also trended longer by an average of 44 s (P ¼ 0.07). The number of doses of ampicillin received in the first week correlated with the degree of prolongation in bleeding time (r ¼ 0.68). Conclusion:Over the first week of life, a period when the bleeding time of VLBW neonates normally shortens, the opposite occurred (the bleeding time lengthened) if X10 doses of ampicillin were administered.

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Shorter PFA‐100® closure times in neonates than in adults: role of red cells, white cells, platelets and von Willebrand factor

Cited by 89 publications

References 27 publications

Effect of ampicillin on the bleeding time of neonatal intensive care unit patients

Effect of ampicillin on the bleeding time of neonatal intensive care unit patients

Ibuprofen lysine administration to neonates with a patent ductus arteriosus: effect on platelet plug formation assessed by in vivo and in vitro measurements

Effect of ampicillin on bleeding time in very low birth-weight neonates during the first week after birth

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