Coagulopathy screening and early plasma treatment for the prevention of intraventricular hemorrhage in preterm infants

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2009-12, Vol.49 (12), p.2637-2644
• Main Authors: DANI, Carlo, POGGI, Chiara, CECIARINI, Federica, BERTINI, Giovanna, PRATESI, Simone, RUBALTELLI, Firmino F
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Coagulation Disorders - diagnosis; Blood Coagulation Disorders - epidemiology; Blood Coagulation Disorders - therapy; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Cerebral Hemorrhage - epidemiology; Cerebral Hemorrhage - prevention & control; Cerebral Ventricles; Cohort Studies; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Erythrocyte Transfusion - statistics & numerical data; Female; Gestational Age; Humans; Incidence; Infant, Newborn; Infant, Premature - blood; Intensive care medicine; Male; Medical sciences; Neonatal Screening; Plasma; Platelet Transfusion - statistics & numerical data; Prospective Studies; Risk Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/j.1537-2995.2009.02328.x

Despite the improvement in the assistance and treatment of preterm infants, intraventricular hemorrhage (IVH) remains a frequent complication in these patients. Our aim was to demonstrate the hypothesis that a coagulopathy screening and the early treatment with fresh-frozen plasma (FFP) of proven coagulopathy may contribute to decrease the occurrence of IVH in infants with gestational age of less than 29 weeks. This study compared two cohorts of infants who received FFP (10 mL/kg) after the evidence of pathologic coagulation tests performed within 2 hours after birth (screening group, n = 127) or after the development of bleedings and evidence of pathologic coagulation tests (no-screening group, n = 91). The screening strategy decreased the relative risk (RR) of developing IVH (RR = 0.65; 95% confidence interval, 0.44-0.98) compared to no-screening strategy, but the effect was limited to infants born at 23 to 26 weeks of gestation in whom screening strategy lowered IVH occurrence (34.5% vs. 61.1%, p = 0.008). A coagulopathy screening strategy decreases the risk of developing IVH in preterm infants but this effect is limited to infants born at 23 to 26 weeks of gestation.