Coagulopathy in newborns with hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia: a retrospective case-control study.
Coagulopathy in newborns with hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia: a retrospective case-control study.
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DOI：
10.1186/1471-2431-14-277
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发表时间：
2014-11-03
期刊：
影响因子：
2.4
通讯作者：
Massaro AN
中科院分区：
文献类型：
--
作者：
Forman KR;Diab Y;Wong EC;Baumgart S;Luban NL;Massaro AN
新生儿缺氧缺血性脑病(HIE)是全身缺氧所致的凝血障碍的危险因素。此外，治疗性低温(TH)会减缓凝血级联反应的酶活性，导致常规评估的凝血研究的结构性延长。预测出血的实验室异常程度尚不清楚，导致不同的输血治疗方法。2008-2012年间接受TH治疗的HIE婴儿被纳入这项回顾性研究。收集国际标准化比率(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)和血小板(PLT)的初始值、最小值(Min)和最大值(Max)。出血被定义为临床上有意义的出血，如果与1)24小时内血红蛋白(Hb)下降2微克/分升，2)输血产品止血，或3)关键器官系统受累有关。比较出血组(BG)和非出血组(NBG)的实验室指标。使用受试者操作特征曲线(ROC)分析评估组间显著不同的变量，以确定预测出血的切点。新生儿出生体重(±SD)3.34 ± 0.67 kg，胎龄38.6 ± 1.9wk。BG包括41名婴儿。出血部位：颅内(n = )13例，胃肠道(n = )19例，肺(n = )18例，血尿(n = )11例，其他(n = )1例。BG和NBG在基线特征上没有差异(p >； 0.05)。两组新生儿的INR和aPTT值均超出可接受的参考范围。与NBG相比，BG具有较高的初始INR、最大INR、初始aPTT、较低的最小PLT和最小Fib。ROC分析显示，血小板计数130×109/L、纤维蛋白原水平1.5g/L和INR>；2是BG与NBG的鉴别指标。在接受TH治疗的HIE婴儿中，凝血障碍的实验室证据是普遍的。维持血小板计数&130×109/L、纤维蛋白原水平和1.5g/L以及异丙肾上腺素水平的输血策略可能会在这一高危人群中预防临床出血。
Newborns with hypoxic ischemic encephalopathy (HIE) are at risk for coagulopathy due to systemic oxygen 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 abnormality that predicts bleeding is unclear, leading to varying transfusion therapy practices. 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 thromboplastin time (aPTT), fibrinogen (Fib) and platelet (PLT) count (measured twice daily during TH) were collected. Bleeding was defined as clinically significant if associated with 1) decreased hemoglobin (Hb) by 2 g/dL in 24 hours, 2) transfusion of blood products for hemostasis, or 3) involvement of a critical organ system. Laboratory data between the bleeding group (BG) and non-bleeding group (NBG) were compared. Variables that differed significantly between groups were evaluated with Receiver Operating Characteristic Curve (ROC) analyses to determine cut-points to predict bleeding. Laboratory and bleeding data were collected from a total of 76 HIE infants with a mean (±SD) birthweight of 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 differences between BG and NBG in baseline characteristics (p > 0.05). Both groups demonstrated INR and aPTT values beyond the 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, fib level <1.5 g/L, and INR >2 discriminated BG from NBG. Laboratory evidence of coagulopathy is universal in HIE babies undergoing TH. Transfusion strategies to maintain PLT counts >130 × 109/L, fib level >1.5 g/L, and INR <2 may prevent clinical bleeding in this high risk population.
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影响因子：
48
作者：
Rutherford, Mary;Ramenghi, Luca A.;Edwards, A. David;Brocklehurst, Peter;Halliday, Henry;Levene, Malcolm;Strohm, Brenda;Thoresen, Marianne;Whitelaw, Andrew;Azzopardi, Denis
通讯作者：
Azzopardi, Denis
DOI：
10.1097/00005373-199209000-00022
发表时间：
1992-09-01
影响因子：
--
作者：
REED, RL;JOHNSTON, TD;FISCHER, RP
通讯作者：
FISCHER, RP
影响因子：
168.9
作者：
Gluckman, PD;Wyatt, JS;Gunn, AJ
通讯作者：
Gunn, AJ
影响因子：
2.4
作者：
Azzopardi D;Brocklehurst P;Edwards D;Halliday H;Levene M;Thoresen M;Whitelaw A;TOBY Study Group
通讯作者：
TOBY Study Group
影响因子：
6.5
作者：
Michelson, AD;Barnard, MR;Valeri, CR
通讯作者：
Valeri, CR