ANTITHROMBIN-III SUBSTITUTION IN PRETERM INFANTS - EFFECT ON INTRACRANIAL HEMORRHAGE AND COAGULATION PARAMETERS

In preterm infants the activity of antithrombin III (AT-III), the main inhibitor of thrombin, is reduced depending on gestational age and co mplications such as sepsis or respiratory distress syndrome. Babies wi th low levels of AT-III have been shown to have a higher mortality and an increased incidence of intracranial hemorrhage, In our study we tr ied to shaw the effect of early AT-III substitution on coagulation par ameters and the incidence of intraventricular hemorrhage (IVH). One hu ndred three preterm infants at a gestational age of 25-32 weeks (mean 28.9 weeks; birth weight 600-2,170 g, mean 1.285 g) received AT-III co ncentrate at a single dosage of 50-200 IU/kg on the day of birth and s ubsequently; only in case of a neu decrease below an AT-III activity o f 50 %. We measured AT-III activity. Quick's prothrombin time (PT), pa rtial thromboplastin time (PTT) and platelet count on the day of birth , and after 1 and 5-9 days in 25 patients. AT-III activity before subs titution was lower than described for term infants (20-72 %, mean 40 % ). Within the first week of life Quick's PT and PTT reached almost ter m values. No significant differences of the: platelet count were found within the first week of life. The incidence of IVH was lower than in current epidemiologic studies: in only 13 % of the study patients. Si x percent of the infants had IVH grade I, 3 % grade II, 4 % grade III and none grade IV. Therefore, in preterm infants AT-III substitution m ay reduce the incidence and progression of intracranial hemorrhage.