| Objective:To understand the current situation of plasma hypofibrinogenemia in non-surgical hospitalized neonates in our hospital,to explore the related factors of neonatal hypofibrinogenemia,the risk of bleeding,and the effectiveness and necessity of clinical routine treatment.Methods:Retrospectively analyze the clinical data of 863 hospitalized neonates,who had been detected at least once of hypofibrinogenemia(FIB<1.0g/L)in the Department of Laboratory Medicine from June 1,2015 to March 31,2016;and had no history of surgery or more than 24 hours of hospitalization history outside our hospital.Analyze the correlation between the degree of neonatal hypofibrinogenemia and gender,gestational age,age,birth weight,mode of delivery,multiple births,maternal disease status,hypoxic history,intravenous nutrition,exchange transfusion,clinical complications(including infection,acidosis,liver function impairment,hypoalbuminemia,and hyperbilirubinemia);and the correlation with the risk and severity of bleeding.Results:1.Among the 863 newborns,492 were male and 371 werefemale.The male to female ratio was about 4 to3.2.Neonatal hypofibrinogenemia occurred among all gestational ages,ages,and birth weights,with a minimum gestational age of 27+1 weeks,a maximum of 43+3 weeks,and a high percentage of premature infants(54%).The lowest birth weight was 770 g,the highest was 5050 g,the average weight was 2556.3±738.4g,and the proportion of normal weight neonates(2500-3999g)was the largest proportion(53.1%).Most cases(548 cases,63.5%)were 0-2 days old.Among gestational age-related birth weights,AGA had a highest ratio(74.0%).3.Infectious disease(752 cases,87.1%)constituted most of the complications,of which pneumonia was the most common disease.Contributing to noninfectious diseases,in order of proportion,there were hyperbilirubinemia,hypoalbuminemia,respiratory failure,newborn asphyxia,acidosis,NRDS,neonatal hemolytic disease,liver function impairment,and only 3.4% cases without complications mentioned above.The special treatment during hospitalization in this study included intravenous nutrition,exchange transfusions,and ventilator-assisted breathing.4.The most severe hypofibrinogenemia in this study was as low as0.18 g/L,with the slightest being 0.99 g/L.The proportion of patients with mild reduction was 62.2%,and those with severe reduction were relatively rare(8.8%).5.In univariate analysis,maternal morbidity,mode of delivery,number of fetuses,neonatal history of intrauterine distress,complications of pneumonia,NEC,liver function impairment,hemolytic disease,hyperbilirubinemia,exchange transfusion,and ventilator use did not affect the degree of hypofibrinogenemia(P> 0.05).The weight and gestational age were negatively correlated with the degree of reduction.The smaller the body weight to gestational age,the more likely the fibrinogen was to reduce severely.On the contrary,the age was positively correlated with the degree of reduction.The greater the age,the greater possibility of severe reduction.Newborns with a history of asphyxia,history of intravenous nutrition,combined sepsis,other infections,respiratory failure,NRDS,and hypoalbuminemia all increased the likelihood of severe hypofibrinogenemia(P<0.05).6.In a multivariate logistic regression model,birth weight less than1500 g,age greater than 2 days,SGA,combined respiratory failure,and intravenous nutrition were the independent risk factors for aggravating fibrinogen levels(P<0.05).7.Among the 863 newborns,247 cases(28.6%)suffered from hemorrhage.The common sites of bleeding were gastrointestinal tract,intracranial,respiratory tract,skull and others.Of these,202 patients had confirmed or suspected having bleeding causes(such as birth canal squeezing,gastric lavage,tracheal intubation,and other invasiveprocedures).16 patients had severe bleeding,which occurred in the digestive tract and respiratory tract,and 4 patients of severe pneumorrhagia had poor prognosis.8.Among the 863 neonates,726 cases(84.1%)were associated with other coagulation-related abnormalities,of which 670 cases(77.6%)had prolonged APTT,suggesting that neonatal disease has a significant effect on the endogenous coagulation system.9.There was no significant difference in the incidence of hemorrhage,the number of bleeding sites and the severity of hemorrhage,whether it associated with abnormal blood coagulation-related abnormalities or not(P>0.05).There was no significant difference in bleeding incidence,number of bleeding sites,and bleeding degree when fibrinogen was reduced to different degrees(P>0.05).10.Among the 863 newborns,regardless of the severity of hypofibrinogenemia and the presence or absence of hemorrhage,some fibrinogen replacement therapy was performed.A total of 68 cases(7.9%)were treated with infusion of fresh frozen plasma and cryoprecipitate was more common;59 cases(77.6%)with severe hypofibrinogenemia and 217cases(87.9%)with hemorrhage did not receive replacement therapy.11.69 cases(8.0%)had follow-up fibrinogen levels,of which 18 cases(26.1%)had a history of fibrinogen replacement therapy,and 25 cases(36.2%)had bleeding and no severe bleeding case.Comparing pre-andpost-fibrinogen levels,the results of follow-up fibrinogen levels were significantly higher than those before follow-up(P<0.05)regardless of whether there was bleeding or treatment.There was no significant difference in the added value of fibrinogen between the group received replacement therapy and no treatment group(P>0.05).12.The degree of hypofibrinogenemia was not significantly related to the outcome of neonatal hospitalization(P>0.05).Conclusion : The incidence of hypofibrinogenemia was higher in non-surgical neonates hospitalized within 2 days,SGA,birth weight less than 1500 g,combined respiratory failure,intravenous nutrition can aggravate the decrease of neonatal fibrinogen.Simple hypofibrinogenemia and hypofibrinogenemia combined with other coagulation abnormalities,both could not predict bleeding risk or bleeding severity.Clinically there is no consensus on the treatment of neonatal hypofibrinogenemia.Given the limitations of this study,it is not yet possible to assess whether substitution therapy has an advantage in increasing the level of fibrinogen in the newborn.Regardless of the degree of severity of hypofibrinogenemia,spontaneous bleeding may occur.Clinical attention must be paid to the bleeding tendency and individualized preventive measures should be formulated. |
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