Coagulation abnormalities and severe intraventricular hemorrhage in extremely low birth weight infants

Background. The association between intraventricular hemorrhage (IVH) and coagulation in infants has been a subject of controversy. Only few publications assessing risk factors for development of IVH reported results of coagulation studies. Objectives. To evaluate the levels of coagulation and fibrinolysis systems in ELBW infants and determine their influence on IVH. Patients and methods. Following IRB approval coagulation status of 38 ELBW infants was evaluated on first and second day of life. Severity of IVH assessed by cerebral ultrasonography was graded according to Papile classification. Newborns were assigned to either Group A - Grade III or IV, or Group B - Grade I-II, or no IVH. Results. Neonates with Grade III/IV IVH had significantly lower plasma Factor VII ( FVII) level on first day of life and FVII differed significantly between Groups A and B with sensitivity of 100%, specificity 41% for a cut-off value of 57%. In Group A there was no improvement of prothrombin and activated partial thromboplastin times on Day 2. A significant decline of platelet count was also observed. Conclusions. High-grade IVH coincides with severe derangement of coagulation in ELBW infants with FVII level being the most sensitive, it is not clear what reason for such low FVII concentration is. Further studies are indicated.