Can coagulopathy screening predict severe intraventricular haemorrhage in extremely preterm infants?.

Background: Intraventricular haemorrhage (IVH) continues to be a significant contributor to neonatal morbidity and mortality, especially in the extremely premature population (<26 weeks). The aims of the study were to test the hypothesis that risk based coagulopathy screening could identify infants at risk of severe IVH/mortality, and whether preterm infants born at <26 weeks of gestation who received early fresh frozen plasma (FFP) had a lower incidence of IVH than those who did not. Method(s): Chart review of preterm infants born <26 week gestation was conducted. The study compared two cohorts of infants who either had risk based coagulopathy screening (within first 48 h, n = 47) or no screening (n = 55). Result(s): Baseline and clinical characteristics of the two cohorts were similar. Risk based coagulopathy screening predicted infants at risk of severe IVH (relative risk (RR), 2.59, 95% confidence interval (CI) 1.18-5.67, P < 0.01) but not mortality (RR 1.2, CI 0.79-1.94). FFP was administered significantly more in the screened cohort (P < 0.001); however the incidence of IVH was similar in those who received early FFP administration than those who did not. Conclusion(s): Risk based coagulopathy screening may identify preterm infants at risk of severe IVH; however the study failed to show any benefit of early treatment of a coagulopathy in a small but high risk population.