TY - JOUR
T1 - Coagulopathy in newborns with hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia
T2 - A retrospective case-control study
AU - Forman, Katie R.
AU - Diab, Yaser
AU - Wong, Edward C.C.
AU - Baumgart, Stephen
AU - Luban, Naomi L.C.
AU - Massaro, An N.
N1 - Funding Information:
Dr. Massaro was supported by Award Numbers UL1TR000075 and KL2TR000076 from the NIH National Center for Advancing Translational Sciences (NCATS). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health. The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Publisher Copyright:
© 2014 Forman et al.
PY - 2014/11/3
Y1 - 2014/11/3
N2 - Background: Newborns with hypoxic ischemic encephalopathy (HIE) are at risk for coagulopathy due to systemicoxygen deprivation. Additionally, therapeutic hypothermia (TH) slows enzymatic activity of the coagulation cascade,leading to constitutive prolongation of routinely assessed coagulation studies. The level of laboratory abnormalitythat predicts bleeding is unclear, leading to varying transfusion therapy practices.Methods: HIE infants treated with TH between 2008-2012 were included in this retrospective study. Initial,minimum (min) and maximum (max) values of International Normalized Ratio (INR), activated partial thromboplastintime (aPTT), fibrinogen (Fib) and platelet (PLT) count (measured twice daily during TH) were collected. Bleedingwas defined as clinically significant if associated with 1) decreased hemoglobin (Hb) by 2 g/dL in 24 hours, 2) transfusionof blood products for hemostasis, or 3) involvement of a critical organ system. Laboratory data between thebleeding group (BG) and non-bleeding group (NBG) were compared. Variables that differed significantlybetween groups were evaluated with Receiver Operating Characteristic Curve (ROC) analyses to determinecut-points to predict bleeding.Results: Laboratory and bleeding data were collected from a total of 76 HIE infants with a mean (±SD) birthweightof 3.34 ± 0.67 kg and gestational age of 38.6 ± 1.9 wks. BG included 41 infants. Bleeding sites were intracranial(n = 13), gastrointestinal (n = 19), pulmonary (n = 18), hematuria (n = 11) or other (n = 1). There were no differencesbetween BG and NBG in baseline characteristics (p > 0.05). Both groups demonstrated INR and aPTT values beyondthe acceptable reference ranges utilized for full tem newborns. BG had higher initial and max INR, initial aPTT,and lower min PLT and min Fib compared to NBG. ROC analyses revealed that platelet count <130 × 109/L, fiblevel <1.5 g/L, and INR >2 discriminated BG from NBG.Conclusions: Laboratory evidence of coagulopathy is universal in HIE babies undergoing TH. Transfusion strategiesto maintain PLT counts >130 × 109/L, fib level >1.5 g/L, and INR <2 may prevent clinical bleeding in this highrisk population.
AB - Background: Newborns with hypoxic ischemic encephalopathy (HIE) are at risk for coagulopathy due to systemicoxygen deprivation. Additionally, therapeutic hypothermia (TH) slows enzymatic activity of the coagulation cascade,leading to constitutive prolongation of routinely assessed coagulation studies. The level of laboratory abnormalitythat predicts bleeding is unclear, leading to varying transfusion therapy practices.Methods: HIE infants treated with TH between 2008-2012 were included in this retrospective study. Initial,minimum (min) and maximum (max) values of International Normalized Ratio (INR), activated partial thromboplastintime (aPTT), fibrinogen (Fib) and platelet (PLT) count (measured twice daily during TH) were collected. Bleedingwas defined as clinically significant if associated with 1) decreased hemoglobin (Hb) by 2 g/dL in 24 hours, 2) transfusionof blood products for hemostasis, or 3) involvement of a critical organ system. Laboratory data between thebleeding group (BG) and non-bleeding group (NBG) were compared. Variables that differed significantlybetween groups were evaluated with Receiver Operating Characteristic Curve (ROC) analyses to determinecut-points to predict bleeding.Results: Laboratory and bleeding data were collected from a total of 76 HIE infants with a mean (±SD) birthweightof 3.34 ± 0.67 kg and gestational age of 38.6 ± 1.9 wks. BG included 41 infants. Bleeding sites were intracranial(n = 13), gastrointestinal (n = 19), pulmonary (n = 18), hematuria (n = 11) or other (n = 1). There were no differencesbetween BG and NBG in baseline characteristics (p > 0.05). Both groups demonstrated INR and aPTT values beyondthe acceptable reference ranges utilized for full tem newborns. BG had higher initial and max INR, initial aPTT,and lower min PLT and min Fib compared to NBG. ROC analyses revealed that platelet count <130 × 109/L, fiblevel <1.5 g/L, and INR >2 discriminated BG from NBG.Conclusions: Laboratory evidence of coagulopathy is universal in HIE babies undergoing TH. Transfusion strategiesto maintain PLT counts >130 × 109/L, fib level >1.5 g/L, and INR <2 may prevent clinical bleeding in this highrisk population.
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U2 - 10.1186/1471-2431-14-277
DO - 10.1186/1471-2431-14-277
M3 - Article
C2 - 25367591
AN - SCOPUS:84920821932
SN - 1471-2431
VL - 14
JO - BMC Pediatrics
JF - BMC Pediatrics
IS - 1
M1 - 277
ER -