COAGULATION AND FIBRINOLYTIC SYSTEMS IN THE ILL PRETERM NEWBORN

Aim: The activation pattern of the clotting and fibrinolytic systems i n 63 preterm infants (GA 31, 6 +/- 2.3 weeks) was studied, Methods: Th e infants were divided into four groups: (i) IRDS, (ii) asphyxia at bi rth, (iii) sepsis, and (iv) mild infection. A control group was compos ed of preterm infants without any apparent disease (GA 32 +/- 1.8 week s). Results: During IRDS we found a systemic activation of both coagul ation and fibrinolysis at birth which was represented by lower levels of ATIII (27.7 +/- 8.8%) and significantly greater levels of TAT (37.9 +/- 31.9 ng/ml), D-dimers (1242.7 +/- 206.9 ng/ml), tPA Ag (10.9 +/- 5.3 ng/ml) and PAI Ag (59.9 +/- 16.7 ng/ml) than in the control group. In the asphyxiated newborns there were no significant differences fro m the controls. During their seventh day of life, a significant reduct ion of all the analysed parameters (TAT, D-dimers, tPA, PAI) and a sig nificant increase in ATIII were seen in the newborns with IRDS, while no significant modification was observed in the newborns with asphyxia at birth. When the newborns with sepsis were compared with those with mild infection, their TAT and PAI values proved to be significantly h igher for the first tests (21.7 +/- 18.8 vs 9.2 +/- 6.9 mu g/l and 53. 6 +/- 14.4 vs 37.7 +/- 10.2 ng/ml respectively). During the second tes ts, 7 days later, only TAT (16.7 +/- 14.7 vs 6.3 +/- 4 mu g/l) levels remained high while D-dimers (1094.2 +/- 400.6 vs 646 +/- 200 ng/ml) a nd tPA (11.3 +/- 8 vs 4.9 +/- 2 ng/mL) were significantly higher in th e septic group of newborns than those with mild infection. Conclusions : These data indicate that there is an activation of the clotting and fibrinolytic systems both in the initial phase of IRDS as well as duri ng sepsis.