背景:在文献中,目前尚无关于接受治疗性低温(TH)的缺氧缺血性脑病(HIE)新生儿输血阈值的研究.为了便于准确解释这些新生儿的凝血结果,我们的目标是在这一特定人群中产生特定的参考区间.
方法:这项回顾性研究纳入了2014年至2022年收治的所有接受TH的HIE新生儿。所有婴儿在TH期间都接受了血液检查,包括凝血曲线。我们的主要结果是评估第三个的估计,第十,25日,50岁,75,第90,入院时(输血前)每个参数的第97百分位数。通过接收机工作特性(ROC)分析,ROC曲线下面积(AUC)和最佳临界点用于评估以国际标准化比值(PT-INR)表示的凝血酶原时间预测任何出血风险的能力.
结果:本研究共纳入143名婴儿。一入场,纤维蛋白原中值为205mg/dL,凝血酶原时间18.6秒,PT-INR1.50,活化部分凝血活酶时间38.3秒,凝血酶时间18.6秒,抗凝血酶57.0%。预测任何出血风险的PT-INR的最佳临界值大于1.84(AUC.623,p=.024)。
结论:第一次,我们提出了HIE新生儿队列中凝血参数的百分位数.此外,我们发现PT-INR大于1.84可以显著预测出血风险.需要进一步的研究来确定限制性输血与自由输血方法对于这些高危婴儿是否同样安全。
BACKGROUND: In the literature, there are no studies about the transfusion threshold for neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). In order to facilitate accurate interpretation of coagulation results in these neonates, we aimed to generate specific reference intervals in this specific population.
METHODS: This retrospective study included all HIE neonates admitted from 2014 to 2022 to undergo TH. All infants during TH underwent blood exams, including the coagulation profile. Our primary outcome was to assess the estimates of the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles for each parameter on admission (before transfusion). By the receiver operating characteristic (ROC) analysis, the area under the ROC curve (AUC) and the best cut-off point were used to evaluate the ability of the prothrombin time expressed as international normalized ratio (PT-INR) to predict the risk of any bleeding.
RESULTS: A total of 143 infants were included in this study. On admission, the median fibrinogen value was 205 mg/dL, prothrombin time 18.6 seconds, PT-INR 1.50, activated partial thromboplastin time 38.3 seconds, thrombin time 18.6 seconds, antithrombin 57.0%. The optimal cut-off of PT-INR in predicting the risk of any bleeding was greater than 1.84 (AUC .623, p = .024).
CONCLUSIONS: For the first time, we proposed the percentiles of coagulation parameters in our cohort of neonates with HIE. Furthermore, we found that a PT-INR greater than 1.84 can significantly predict the risk of any bleeding. Further studies are needed to determine if a restrictive versus a liberal transfusion approach can be equally safer for these high-risk infants.