Clinical Characteristics of Hospitalized Neonates With Hypofibrinogenemia: A Retrospective Cohort Study.
Clinical Characteristics of Hospitalized Neonates With Hypofibrinogenemia: A Retrospective Cohort Study.
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DOI：
10.3389/fped.2020.00589
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发表时间：
2020
影响因子：
2.6
通讯作者：
Yan L
中科院分区：
文献类型：
--
作者：
Zhou W;He Y;Li Q;Li Y;Su Y;Yan L
背景：新生儿低纤维蛋白原血症通常无症状，但可表现为出血。
目的：本研究旨在描述低纤维蛋白原血症新生儿的临床特征，并确定与出血相关的因素。
方法：这是一项对2012年1月至2017年12月在中国重庆人民医院新生儿科住院的血浆纤维蛋白原水平（FIB）≤1.0 g/L的新生儿的回顾性研究。根据严重程度，患者被分为重度、中度和轻度低纤维蛋白原血症（分别为FIB < 0.5 g/L、0.5 g/L ≤ FIB < 0.7 g/L和0.7 g/L ≤ FIB ≤ 1.0 g/L）。分析了与出血相关的临床特征。
结果：在330名新生儿中，52.7%为轻度低纤维蛋白原血症，25.5%为中度低纤维蛋白原血症，21.8%为重度低纤维蛋白原血症。重度低纤维蛋白原血症与胎龄无关，但轻度低纤维蛋白原血症在低出生体重/正常出生体重的新生儿中较为常见（P = 0.018）。大约80.6%的新生儿表现为低纤维蛋白原血症与血小板减少或凝血功能障碍的不同组合。38.8%的病例发生出血，其中60.9%为轻度出血。出血表现为穿刺部位出血（47.7%）或自发性皮肤/黏膜出血（34.2%）。低纤维蛋白原血症的程度与出血的严重程度或发生无关。在低纤维蛋白原血症且出血的患者中，53.4%伴有凝血功能障碍的病例表现为轻度出血，85.7%伴有血小板减少的病例为中度出血，而53.8%伴有凝血功能障碍和血小板减少的病例为重度出血。
结论：新生儿低纤维蛋白原血症常合并其他疾病，并与血小板减少和/或凝血功能障碍同时发生。尽管出血与低纤维蛋白原血症的程度无关，但当低纤维蛋白原血症与凝血功能障碍和/或血小板减少同时发生时，出血可能会很严重。
Background: Neonatal hypofibrinogenemia is often asymptomatic but can manifest as hemorrhage. Objective: This study was conducted to characterize clinical characteristics of neonates with hypofibrinogenemia and identify factors associated with hemorrhage. Methods: This was a retrospective study of neonates with plasma fibrinogen level (FIB) ≤1.0 g/L who were hospitalized at the Neonatology Department, People's Hospital, Chongqing, China, from January 2012 to December 2017. Based on severity, patients were grouped into severe, moderate, and mild hypofibrinogenemia (FIB < 0.5 g/L, 0.5 g/L ≤ FIB < 0.7 g/L, and 0.7 g/L ≤ FIB ≤ 1.0 g/L, respectively). Clinical characteristics associated with hemorrhage were analyzed. Results: Among 330 neonates, 52.7% showed mild hypofibrinogenemia, 25.5% had moderate hypofibrinogenemia, and 21.8% had severe hypofibrinogenemia. Severe hypofibrinogenemia was not associated with gestational age, but the mild form was frequent in neonates with low/normal birthweight (P = 0.018). Approximately 80.6% of neonates presented hypofibrinogenemia as variable combinations of thrombocytopenia or coagulopathies. Hemorrhage occurred in 38.8% of the cases, 60.9% of which were mild. Hemorrhage manifested as puncture site bleeding (47.7%) or spontaneous skin/mucous membrane bleeding (34.2%). The degree of hypofibrinogenemia was not associated with the severity or occurrence of hemorrhage. Among patients with hypofibrinogenemia and bleeding, 53.4% of the cases with coagulopathies showed mild hemorrhage, 85.7% of the cases with thrombocytopenia had moderate bleeding, while 53.8% of the cases with coagulopathy and thrombocytopenia showed severe hemorrhage. Conclusion: Neonatal hypofibrinogenemia is often comorbid and occurs with thrombocytopenia and/or coagulopathies. Although hemorrhage is not associated with the degree of hypofibrinogenemia, it may be severe when hypofibrinogenemia co-occurs with coagulopathies and/or thrombocytopenia.
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