Abstracts

Abstract

Background: IVH is a significant cause of morbidity and mortality in extremely premature infants. Despite extensive study, little is known about hemostatic disruptions contributing to IVH or normal coagulation parameters < 30 weeks gestational age (GA). Aims: To characterize coagulation parameters in < 30 week GA neonates and evaluate risk factors associated with IVH. Methods: In a prospective observational study, cord blood was obtained from neonates 23-30 weeks GA at the time of birth. Neonates were enrolled from 11/2010-01/2015, 507 neonates were screened, 336 consented and 120 enrolled for analysis. PT/INR, aPTT, Factor II, Factor VII, Factor IX, Factor X, Factor XIII, and Factor XIII subunit A were measured. Data was collected as reported to the Vermont-Oxford Network (VON). Clinical variables defined by VON were used to analyze association with IVH. Results: 24.2% (29/120) neonates enrolled developed IVH. Mean GA and birth weight of all neonates was 27.1 (23.3-30) weeks and 933.8 (375-1800) grams. Table 1 shows coagulation tests by GA. Number per test vary due to plasma availability for evaluation. There was no significant difference among coagulation tests in neonates with/without IVH or by GA. VON clinical variables were analyzed by Fisher exact test and chi-square: for all neonates, chronic lung disease (CLD, P = 0.032) and persistent pulmonary hypertension (PPHN, P = 0.02) were significantly associated with IVH, and anemia approached significance (P = 0.054). Further, CLD, OR 2.5(95% CI 1.07-5.87), P = 0.035 and PPHN, OR 6.11(95% CI 1.36-27.41), P = 0.018; and anemia, OR 4.05 (95% CI 0.89-18.46), P = 0.071 approached significance. 24 additional variables analyzed were not significantly associated with IVH. Conclusions: We report the largest, prospective study to date of coagulation parameters and risk factors associated with IVH in extremely premature neonates. CLD and PPHN were significantly associated with IVH, and suggest tenuous hemodynamic flow associated with these conditions may alert clinicians to potential IVH.