Intraventricular haemorrhage in very-low-birthweight preterm infants:: Association with low prothrombin activity at birth

Aim: To determine the occurrence of intraventricular haemorrhage (IVH) and its association with coagulation factors at birth in preterm neonates born before 30 wk gestation. Methods: 38 neonates (median gestational age 27 wk, range 24 - 29 wk; median birthweight (BW) 933 g, range 515 - 1760 g) admitted to the neonatal intensive care unit were studied. Blood samples for coagulation factors were taken within 2 h after birth. The first cranial ultrasonographic examination was performed within the first 3 d. The occurrence of IVH was tested statistically by the Mann-Whitney U-test for association with the activity of coagulation factors and clinical variables. Results: Thirteen IVHs occurred within the first 3 d of life. IVH was associated with BW < 1000 g (p = 0.012), low mean blood pressure within the first 2 d (p = 0.026), gestational age < 27 wk (p = 0.054), low Apgar scores (57) at 1 min (p = 0.078) and intrauterine growth restriction (p = 0.072). At birth (samples drawn with a median of first 36 min of life), infants with subsequent IVH had statistically significantly lower prothrombin (factor II) activity (p = 0.024) than infants without IVH. Conclusion: The measured low prothrombin may have been affected by a prior bleeding event. Nevertheless, preterm infants with low prothrombin activity may be susceptible to IVH, or to the progression of it, if left undiagnosed.