Abstract Number: PB1255
Meeting: ISTH 2020 Congress
Background: Parenteral nutrition (PN) associated cholestasis (PNAC) affects one-fifth of neonates receiving PN for more than 2 weeks. Experts suggest vitamin K administration, based on the assumed increased risk of bleeding. However, the hemostatic profile is poorly defined in PNAC.
Aims: To investigate the effect of PNAC on the hemostatic profile of preterm infants.
Methods: This is an ancillary study of a larger prospective observational study aimed at defining hemostasis in preterm infants with gestational age below 32 weeks, in the first month of life. The study was approved by the Ethical Committee and informed consent was obtained from patients’ guardians. In this secondary analysis, we included preterm infants exposed to at least 14 days of PN (standard vitamin K content) and in full enteral feeding at the time of sampling. We excluded patients receiving extra doses of vitamin K before blood withdrawal. We compared thromboelastography-TEG, thrombin generation assay-TGA (lag time-LT; endogenous thrombin potential-ETP with/without thrombomodulin), PT, aPTT and blood count between infants who developed PNAC versus those not affected by PNAC (controls), at 30 days of life.
PNAC was defined based on the value of direct bilirubin ≥2 mg/dl.
Results: We enrolled 92 preterm infants: 32 neonates affected by PNAC and 60 controls (Table 1). As expected, cholestatic patients had a lower birthweight (1065-vs-1275;p=0.001), longer exposure to PN (28-vs-21 days;p=0.001) and longer hospitalization (75 vs 54 days;p=0.005). Infants with PNAC showed longer median PT (12.8 vs 12 sec;p=0.02), aPTT (39.2 vs 36.5 sec;p=0.04) and LT (4.9 vs 4.4 min;p=0.008) than controls. TEG and ETP did not differ between groups (Table 2).
Conclusions: Despite the prolongation of PTs, aPTTs and LT in preterm infants affected by PNAC, both TEG profile and ETP with/without thrombomodulin were similar between the two groups. Further studies are needed to validate the clinical significance of these results.
| 1. NO PNAC (n=60) | 2. PNAC (n=32) | 1 vs 2, p-value | |
| GA (median, range); weeks | 30 (24-32) | 29 (25-32) | ns |
| PCA at the time of sample (median, range); weeks | 34 (28-37) | 35 (30-36) | ns |
| Birthweight (median, range); grams | 1275 (700-1495) | 1065 (660-1490) | 0.001 |
| Gender, male n(%) | 24(40%) | 16(50%) | ns |
| Singleton, n(%) | 25(41.7%) | 17(51.3%) | ns |
| Cesarean section, n(%) | 54(90%) | 26 (81.3%) | ns |
| CRIB II (median, range) | 6 (2-16) | 8(3-14) | 0.018 |
| APGAR 5 minutes (median, range) | 8 (6-10) | 9 (6-10) | ns |
| Lenght of stay (median, range); days | 54 (27-270) | 75 (30-269) | 0.005 |
[Table 1. Demographical data of the study population. GA: gestational age; PCA:post-conceptional age; CRIB II: clinical risk index babies score.]
| 1. NO PNAC | 2. PNAC | 1 vs 2, p-value | |
| Reaction time (sec) | [56] 4.85 (02-16.9) | [31] 4.7 (2.1-14.0) | ns |
| Maximum amplitude (mm) | [56] 71.1 (35.8-79.7) | [31] 71.1 (48.0-77.9) | ns |
| PT (sec) | [57] 12.0 (9.7-16.6) | [32] 12.8 (10.4-16.3) | 0.02 |
| aPTT (sec) | [57] 36.5 (26.1-58.2) | [32] 39.1 (28.3-59.9) | 0.041 |
| Fibrinogen (mg/dl) | [60] 229 (103-393) | [32] 222.5 (117-442) | ns |
| LT_TM (min) | [57] 5.1 (3.1-10.5) | [29] 5.7 (4.6-11.2) | 0.022 |
| ETP_TM | [57] 1108 (444-1905) | [29] 1007 (329-1829) | ns |
| Platelet count (103/µL) | [56] 443 (98-853) | [31] 318 (45-581) | 0.001 |
[Table 2. Hemostatic profile of the study population. Data are expressed as [number] median (range).]
To cite this abstract in AMA style:
Raffaeli G, Ghirardello S, Scalambrino E, Cavallaro G, Mosca F, Peyvandi F, Tripodi A. Hemostasis in Parenteral Nutrition Associated Cholestasis in Preterm Infants: An Observational Study [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/hemostasis-in-parenteral-nutrition-associated-cholestasis-in-preterm-infants-an-observational-study/. Accessed December 10, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/hemostasis-in-parenteral-nutrition-associated-cholestasis-in-preterm-infants-an-observational-study/