Characteristics Of Coagulation Function In Very Premature Infants And Its Correlation With Intracranial Hemorrhage

Objective:Studying the characteristics of coagulation function in very premature infants in the First Affiliated Hospital of Kunming Medical University,and determining the normal reference interval of coagulation values in the extremely premature infants of this unit.To investigate the correlation between coagulation function and intracranial hemorrhage in very premature infants and the effect of infusion of fresh frozen plasma on intracranial hemorrhage.Methods:A retrospective analysis method was used to investigate the clinical problems of coagulation in the very premature infants(gestational age<32 weeks)from the first affiliated hospital of Kunming Medical University from January 2015 to December 2017 from the obstetrics to the pediatric neonatal ward,including Coagulation function,clinical intervention,infusion of fresh frozen plasma and clinical outcomes of periventricular-intraventricular hemorrhage(P-IVH)within one week after birth.Collecting coagulation-related laboratory indicators within 4 hours after birth in very premature infants,including:platelet(PLT),activated partial thromboplastin time(APTT),plasma prothrombin time(PT),thrombin time(TT),fibrinogen(FIB);investigate the condition of infusion of fresh frozen plasma(FFP)after birth in very premature infants,according to whether infusioning FFP divided into FFP group and non-FFP group;investigate the pre-menopausal B-ultrasound examination within one week after birth Results,according to the presence or absence of P-IVH,the children were divided into P-IVH group and no P-IVH group.According to the degree of P-IVH bleeding,they were divided into stages ?,?,? and ?.There were no special perinatal risk factors and statistics.Coagulation parameters of "relatively healthy"very preterm infants with comorbidities,95%reference interval were calculated;differences in coagulation function between P-IVH group and non-P-IVH group and different degrees of P-IVH group were compared;Regression analysis of P-IVH related factors;analysis of the relationship between coagulation function in children with P-IVH and laboratory normal coagulation function reference interval and 95%reference interval of the unit's extremely premature infants;comparison of FFP group and non-FFP group P-IVH And whether there is a difference in the incidence of different degrees of P-IVH.Results:1.A total of 334 very premature infants entered the survey.Among them,272 very premature infants met the survey conditions,143 males and 129 females.There was no significant difference in gender between men and women.The average gestational age was 30.22±1.47 weeks,and the average was born.Body weight 1350.2 ± 291,87g;mother with diabetes mellitus in 50 cases,mother with pregnancy-induced hypertension in 80 cases,placental abruption in 16 cases,birth asphyxia in 23 cases,intrauterine distress in 15 cases,early bacterial infection in 103 cases,no clear risk factors for children 46 cases.2.Reference interval of coagulation value of very premature infants in this unit:The 95%reference intervals of coagulation test values of 46 "relatively healthy" very preterm infants are:PLT 221.71-257.81 × 109/L,APTT 70.64-87.52s,PT 15.73-22.32s,TT 20.96-23.13s,FIB 1.82-2.38g/L.3.Relationship between coagulation function and periventricular-intraventricular hemorrhage:A total of 84 cases of P-IVH occurred in the first week after birth in 272 preterm infants,including 69 cases in stage I/II and 15 cases in stage ?/? cases of IVH.The p-values of PLT,APTT,PT,TT,and FIB were 0.249,0.876,0.093,0.29,and 0.658,respectively.There was no significant difference between the P-IVH group and the non-P-IVH group.According to the degree of P-IVH hemorrhage,the p values of PLT,APTT,PT,TT and FIB were 0.665,0.802,0.213,0.268,0.446,respectively,in the ?/? phase group compared with the non-P-IVH group.Statistically significant,the p-values of PLT,APTT,PT,TT,and FIB were 0.031,0.858,0.323,0.031,and 0.895,respectively,in the III/IV group compared with the non-P-IVH group.The difference in PLT and PT was statistically significant.P-IVH group has lower PLT and higher PT value.4.Analysis of influencing factors of periventricular-intraventricular hemorrhage:Univariate analysis results suggest that gestational age,birth weight,intrauterine distress,birth asphyxia,5-minute Apgar score,umbilical arterial blood PH,umbilical arterial blood BE value,and recovery mode There were significant differences in the treatment of PT,pulmonary surfactant,mechanical ventilation and the use of booster drugs(p<0.05).Binary logistic regression analysis showed that the OR value of PT was 1.14,p=0.003,that is,PT was a risk factor for P-IVH.The 5-minute Apgar score OR value was 0.78,p=0.038,that is,the 5-minute Apgar score was higher(>7)is a protective factor for P-IVH.5.The relationship between the normal coagulation function reference value of the unit and the periventricular-intraventricular hemorrhage:the 95%reference interval of the APTT value of the unit is the normal reference value standard,and the subjects are divided into APTT extension group and APTT normal.Group,comparing theincidence of P-IVH in the two groups,?2 values were 0.140,p=0.999,the difference was not statistically significant.The reference range of 95%of the PT value of the very premature infants in this unit was the normal reference value standard,and the subjects were divided into PT.The prolongation group and the normal PT group were compared.The incidence of P-IVH was compared between the two groups.The?2 values were 15.323 and p=0.004.The difference was statistically significant.Correlation analysis between APTT and PT and different degrees of IVH showed that the Eta correlation coefficient of APTT was 0.011,and the Eta correlation coefficient of PT was 0.116,indicating that the correlation between APTT and different degrees of P-IVH was not obvious,while PT had different degrees of P.The occurrence of-IVH is significant.6.Effects of infusion of fresh frozen plasma on intraventricular hemorrhage:The survey found that in very premature infants,the clinical standard for neonatal infusion of FFP in our hospital was 2 times the APTT value? adult reference value.Of the 272 very preterm infants,120 were infused with FFP and 152 were not infused with FFP.There were 44 cases of P-IVH in children with uninfused FFP,including 40 cases in stage ? and ?,4 cases in stage ? and ?,and 108 cases of P-IVH.There were 40 cases of P-IVH in the FFP group.There were 29 cases in stage ? and ?,11 cases in stage ? and ?,and 80 cases without P-?H.There was no significant difference in the incidence of intraventricular hemorrhage between the FFP group and the non-infused FFP group.The ?2 values were 5.793,p=0.215.P-IVH stratified study,in the FFP group compared with the non-infused FFP group,in the ?/II P-IVH,the ?2 value was 0.112,p=0.783,the incidence was not statistically significant;III/IV In the P-IVH period,thex values were 0.227 and p=0.634,and the difference in incidence was not statistically significant.Conclusions:1.The 95%reference interval for each coagulation test value of this unit is:PLT 221.71-257.81 × 109/L,APTT 70.64-87.52s,PT 15.73-22.32s,TT 20.96-23.13s,FIB 1.82-2.38g/L.2.There was no significant correlation between ?/? intracranial hemorrhage and coagulation abnormality in children,and the occurrence of stage ?/? intracranial hemorrhage was associated with prolonged prothrombin time and lower platelet count.3.prolonged prothrombin time is a risk factor for intracranial hemorrhage.Apgar high score(>7)5 minutes after birth is a protective factor for intracranial hemorrhage;4.The choice of prophylactic infusion of FFP based on an ATPP value greater than twice the normal adult value does not improve the clinical outcome of intracranial hemorrhage in very preterm infants within one week of birth.