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Development of the human coagulation system in the healthy premature infant
M Andrew, B Paes, R Milner, M Johnston, L Mitchell, DM Tollefsen, V Castle and P Powers
Department of Pediatrics, McMaster University Medical Centre, Hamilton,
Ontario, Canada.
This study was designed to determine the postnatal development of the human
coagulation system in the healthy premature infant. Consecutive mothers of
healthy premature infants born at either St Joseph's Hospital or McMaster
University Medical Centre in Hamilton were asked for consent. One hundred
thirty-seven premature infants (30 to 36 weeks of gestational age) entered
the study. The premature infants did not have any major health problems and
did not require ventilation or supplemental oxygen. Demographic information
and a 20-mL blood sample were obtained in the postnatal period on days 1,
5, 30, 90, and 180. Between 40 and 96 premature infants were studied on
each day for each of the following tests: prothrombin time, activated
partial thromboplastin time, thrombin clotting time, plasminogen; 13 factor
assays [fibrinogen, II, V, VII, VIII, IX, X, XI, XII, XIII, high-mol-wt
kininogen (HMWK), prekallikrein (PK), von Willebrand factor (vWF)] and
eight inhibitors [antithrombin III (AT-III), heparin cofactor II, alpha
2-antiplasmin, alpha 2-macroglobulin, alpha 1-antitrypsin, C1 esterase
inhibitor, protein C (PC), and protein S (PS)]. A combination of biologic
and immunologic assays were used. Between 30 to 36 weeks there was a
minimal effect of gestational age for levels of AT-III, PC, and factors II
and X only; therefore, the entire data set was used to generate reference
ranges for these components of the coagulation system for premature
infants. Next, the results for the premature infants were compared with
those of a previously published study in 118 fullterm infants and with
those for adults. An effect of gestational age was shown for plasminogen,
fibrinogen, factors II, V, VIII, IX, XI, XII, HMWK, and all eight
inhibitors. In general, the postnatal maturation towards adult levels was
accelerated in premature infants as compared with the fullterm infants. By
6 months of age, most components of the coagulation system in premature
infants had achieved near adult values.
Volume 72,
Issue 5,
pp. 1651-1657,
11/01/1988
Copyright © 1988 by The American Society of Hematology

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