Fresh frozen plasma transfusion – a risk factor for pulmonary hemorrhage in extremely low birth weight infants?
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Jakob Usemann
und
Malte Cremer
Abstract
Aim:
To evaluate risk factors for pulmonary hemorrhage (PH) in extremely low birth weight infants (ELBW) taking into consideration coagulation screens, platelet counts, transfusion of fresh frozen plasma (FFP), and platelet concentrates prior to PH.
Patients and methods:
A retrospective case-control study consisting of 20 ELBW infants with PH and 40 matched controls. Coagulation screens, platelet counts at birth and at onset of PH, and transfusion frequencies prior to PH were compared to case-controls at birth and 24–96 h after birth.
Results:
While the initial platelet counts, fibrinogen concentrations, and international normalized ratios were similar in PH infants and controls, the activated partial prothrombin time was prolonged (P=0.05). Compared to 28% of case controls (P<0.05), 55% of infants with later PH received FFP prior to PH. Platelet counts were significantly lower at onset of PH (median 81/nL; range: 37–236/nL) compared to controls (166/nL; 27–460/nL; P<0.005). Multivariate analysis indicated a lack of antenatal steroids, supplemental oxygen, and transfusion of FFP as independent risk factors for PH.
Conclusion:
Prolonged activated partial thromboplastin time (aPTT) might be associated with PH. PH does not primarily depend upon severe thrombocytopenia. A developmental mismatch in hemostasis by transfusion of adult donor plasma should be considered a risk factor for PH.
Acknowledgement
We thank Boris Metze, BSc, for his help in obtaining the clinical data and performing statistical analysis, Petra Blank, Jessica Blank, and Regina Nagel for administrative support, and Karine Landgren Hugentobler for language editing.
Contributors: CD, LG, CB, and MC conceived the study. Clinical data was analyzed by JU; statistics were done by JU and MC. JU, MC, and CD drafted the article, and all authors agreed to the final manuscript.
Funding: None.
Author’s Statement
Conflict of interest: The authors declare that there are no conflicts of interest regarding the publication of this article.
Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.
Ethical approval: The study was approved by the local Institutional Review Board (Ethikkommission der Charité – Universitätsmedizin Berlin) that waived the need to obtain informed parental consent.
References
[1] Alfaleh K, Smyth JA, Roberts RS, Solimano A, Asztalos EV, Schmidt B, et al. Prevention and 18-month outcomes of serious pulmonary hemorrhage in extremely low birth weight infants: results from the trial of indomethacin prophylaxis in preterms. Pediatrics. 2008;121:e233–8.10.1542/peds.2007-0028Suche in Google Scholar
[2] Scholl JE, Yanowitz TD. Pulmonary hemorrhage in very low birth weight infants: a case-control analysis. J Pediatr. 2015;166:1083–4.10.1016/j.jpeds.2014.12.032Suche in Google Scholar
[3] Catford K, Muthukumar P, Reddy C, Al Atrash H, Clarke P, Venkatesh V, et al. Routine neonatal coagulation testing increases use of fresh-frozen plasma. Transfusion. 2014;54:1444–5.10.1111/trf.12610Suche in Google Scholar
[4] Berger TM, Allred EN, Van Marter LJ. Antecedents of clinically significant pulmonary hemorrhage among newborn infants. J Perinatol. 2000;20:295–300.10.1038/sj.jp.7200372Suche in Google Scholar
[5] Stanworth SJ, Clarke P, Watts T, Ballard S, Choo L, Morris T, et al. Prospective, observational study of outcomes in neonates with severe thrombocytopenia. Pediatrics. 2009;124:e826–34.10.1542/peds.2009-0332Suche in Google Scholar
[6] Christensen RD, Baer VL, Lambert DK, Henry E, Ilstrup SJ, Bennett ST. Reference intervals for common coagulation tests of preterm infants (CME). Transfusion. 2014;54:627–32:quiz 6.10.1111/trf.12322Suche in Google Scholar
[7] Duppre P, Sauer H, Giannopoulou EZ, Gortner L, Nunold H, Wagenpfeil S, et al. Cellular and humoral coagulation profiles and occurrence of IVH in VLBW and ELWB infants. Early Hum Dev. 2015;91:695–700.10.1016/j.earlhumdev.2015.09.008Suche in Google Scholar
[8] Batfalsky A, Lohr A, Heussen N, Neunhoeffer F, Orlikowsky TW. Diagnostic value of an interleukin-6 bedside test in term and preterm neonates at the time of clinical suspicion of early- and late-onset bacterial infection. Neonatology. 2012;102:37–44.10.1159/000336632Suche in Google Scholar
[9] Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92:529–34.10.1016/S0022-3476(78)80282-0Suche in Google Scholar
[10] Schmidt B, Roberts RS, Fanaroff A, Davis P, Kirpalani HM, Nwaesei C, et al. Indomethacin prophylaxis, patent ductus arteriosus, and the risk of bronchopulmonary dysplasia: further analyses from the Trial of Indomethacin Prophylaxis in Preterms (TIPP). J Pediatr. 2006;148:730–4.10.1016/j.jpeds.2006.01.047Suche in Google Scholar PubMed
[11] Fowlie PW. Intravenous indomethacin for preventing mortality and morbidity in very low birth weight infants. Cochrane Database Syst Rev. 2000:CD000174.Suche in Google Scholar
[12] Heuchan AM, Evans N, Henderson Smart DJ, Simpson JM. Perinatal risk factors for major intraventricular haemorrhage in the Australian and New Zealand Neonatal Network, 1995–97. Arch Dis Child Fetal Neonatal Ed. 2002;86:F86–90.10.1136/fn.86.2.F86Suche in Google Scholar
[13] Ohlsson A, Roberts RS, Schmidt B, Davis P, Moddeman D, Saigal S, et al. Male/female differences in indomethacin effects in preterm infants. J Pediatr. 2005;147:860–2.10.1016/j.jpeds.2005.07.032Suche in Google Scholar PubMed
[14] Leduc L, Takser L, Rinfret D. Persistance of adverse obstetric and neonatal outcomes in monochorionic twins after exclusion of disorders unique to monochorionic placentation. Am J Obstet Gynecol. 2005;193:1670–5.10.1016/j.ajog.2005.04.007Suche in Google Scholar PubMed
[15] Kassal R, Anwar M, Kashlan F, Smulian J, Hiatt M, Hegyi T. Umbilical vein interleukin-6 levels in very low birth weight infants developing intraventricular hemorrhage. Brain Dev. 2005;27:483–7.10.1016/j.braindev.2004.12.003Suche in Google Scholar PubMed
[16] Roberts IA, Murray NA. Thrombocytopenia in the newborn. Curr Opin Pediatr. 2003;15:17–23.10.1097/00008480-200302000-00004Suche in Google Scholar PubMed
[17] Abou Zahr R, Ashfaq A, Marron-Corwin M. Neonatal pulmonary hemorrhage. NeoReviews. 2012;13:e302–6.10.1542/neo.13-5-e302Suche in Google Scholar
[18] Roth-Kleiner M, Berger TM, Tarek MR, Burri PH, Schittny JC. Neonatal dexamethasone induces premature microvascular maturation of the alveolar capillary network. Dev Dyn. 2005;233:1261–71.10.1002/dvdy.20447Suche in Google Scholar PubMed
[19] Hannam S, Lees C, Edwards RJ, Greenough A. Neonatal coagulopathy in preterm, small-for-gestational-age infants. Biol Neonate. 2003;83:177–81.10.1159/000068928Suche in Google Scholar PubMed
[20] De la Cruz JP, Reyes JJ, Ruiz-Moreno MI, Lopez-Villodres JA, Jebrouni N, Gonzalez-Correa JA. Differences in the in vitro antiplatelet effect of dexibuprofen, ibuprofen, and flurbiprofen in human blood. Anesth Analg. 2010;111:1341–6.10.1213/ANE.0b013e3181f7b679Suche in Google Scholar PubMed
[21] Brunner B, Hoeck M, Schermer E, Streif W, Kiechl-Kohlendorfer U. Patent ductus arteriosus, low platelets, cyclooxygenase inhibitors, and intraventricular hemorrhage in very low birth weight preterm infants. J Pediatr. 2013;163:23–8.10.1016/j.jpeds.2012.12.035Suche in Google Scholar PubMed
[22] Randomised trial of prophylactic early fresh-frozen plasma or gelatin or glucose in preterm babies: outcome at 2 years. Northern Neonatal Nursing Initiative Trial Group. Lancet. 1996;348:229–32.10.1016/S0140-6736(95)12506-XSuche in Google Scholar
[23] A randomized trial comparing the effect of prophylactic intravenous fresh frozen plasma, gelatin or glucose on early mortality and morbidity in preterm babies. The Northern Neonatal Nursing Initiative [NNNI] Trial Group. Eur J Pediatr. 1996;155:580–8.10.1007/BF01957909Suche in Google Scholar PubMed
[24] Kelly AM, Williamson LM. Neonatal transfusion. Early Hum Dev. 2013;89:855–60.10.1016/j.earlhumdev.2013.08.025Suche in Google Scholar PubMed
[25] Pal S, Curley A, Stanworth SJ. Interpretation of clotting tests in the neonate. Arch Dis Child Fetal Neonatal Ed. 2015;100:F270–4.10.1136/archdischild-2014-306196Suche in Google Scholar PubMed
[26] Semple JW, Italiano JE, Jr., Freedman J. Platelets and the immune continuum. Nat Rev Immunol. 2011;11:264–74.10.1038/nri2956Suche in Google Scholar PubMed
[27] Guo Y, Mishra A, Howland E, Zhao C, Shukla D, Weng T, et al. Platelet-derived Wnt antagonist Dickkopf-1 is implicated in ICAM-1/VCAM-1-mediated neutrophilic acute lung inflammation. Blood. 2015;126:2220–9.10.1182/blood-2015-02-622233Suche in Google Scholar PubMed PubMed Central
[28] Hwaiz R, Rahman M, Syk I, Zhang E, Thorlacius H. Rac1-dependent secretion of platelet-derived CCL5 regulates neutrophil recruitment via activation of alveolar macrophages in septic lung injury. J Leukoc Biol. 2015;97:975–84.10.1189/jlb.4A1214-603RSuche in Google Scholar PubMed
©2017 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Review articles
- Mycoplasma/Ureaplasma infection in pregnancy: to screen or not to screen
- Increased rates of cesarean sections and large families: a potentially dangerous combination
- Original articles - Obstetrics
- Clinical chorioamnionitis at term VII: the amniotic fluid cellular immune response
- Clinical chorioamnionitis at term VIII: a rapid MMP-8 test for the identification of intra-amniotic inflammation
- The importance of clinically and ethically fine-tuning decision-making about cesarean delivery
- Use of translabial three-dimensional power Doppler ultrasound for cervical assessment before labor induction
- Perinatal death associated with umbilical cord prolapse
- YKL-40 expression in abnormal invasive placenta cases
- B-type natriuretic peptide and echocardiography reflect volume changes during pregnancy
- Original articles - Fetus
- Evidence-based, ethically justified counseling for fetal bilateral renal agenesis
- Fetal thymus size in pregnant women with diabetic diseases
- Birth weight discordance and adverse perinatal outcomes
- Original articles - Newborn
- Carboxyhemoglobin – the forgotten parameter of neonatal hyperbilirubinemia
- Growth attainment in German children born preterm, and cardiovascular risk factors in adolescence. Analysis of the population representative KiGGS data
- Fresh frozen plasma transfusion – a risk factor for pulmonary hemorrhage in extremely low birth weight infants?
- Letter to the Editor
- Risk factors for uterine rupture with a special interest in uterine fundal pressure: methodological issues
- Congress Calendar
- Congress Calendar
Artikel in diesem Heft
- Frontmatter
- Review articles
- Mycoplasma/Ureaplasma infection in pregnancy: to screen or not to screen
- Increased rates of cesarean sections and large families: a potentially dangerous combination
- Original articles - Obstetrics
- Clinical chorioamnionitis at term VII: the amniotic fluid cellular immune response
- Clinical chorioamnionitis at term VIII: a rapid MMP-8 test for the identification of intra-amniotic inflammation
- The importance of clinically and ethically fine-tuning decision-making about cesarean delivery
- Use of translabial three-dimensional power Doppler ultrasound for cervical assessment before labor induction
- Perinatal death associated with umbilical cord prolapse
- YKL-40 expression in abnormal invasive placenta cases
- B-type natriuretic peptide and echocardiography reflect volume changes during pregnancy
- Original articles - Fetus
- Evidence-based, ethically justified counseling for fetal bilateral renal agenesis
- Fetal thymus size in pregnant women with diabetic diseases
- Birth weight discordance and adverse perinatal outcomes
- Original articles - Newborn
- Carboxyhemoglobin – the forgotten parameter of neonatal hyperbilirubinemia
- Growth attainment in German children born preterm, and cardiovascular risk factors in adolescence. Analysis of the population representative KiGGS data
- Fresh frozen plasma transfusion – a risk factor for pulmonary hemorrhage in extremely low birth weight infants?
- Letter to the Editor
- Risk factors for uterine rupture with a special interest in uterine fundal pressure: methodological issues
- Congress Calendar
- Congress Calendar
