Coagulation abnormalities and severe intraventricular hemorrhage in extremely low birth weight infants.

BACKGROUND: The association between intraventricular hemorrhage (IVH) and coagulation in infants has been a subject of controversy. Only few publications assessing risk factors for development of IVH reported results of coagulation studies. OBJECTIVES: To evaluate the levels of coagulation and fibrinolysis systems in ELBW infants and determine their influence on IVH. PATIENTS AND METHODS: Following IRB approval coagulation status of 38 ELBW infants was evaluated on first and second day of life. Severity of IVH assessed by cerebral ultrasonography was graded according to Papile classification. Newborns were assigned to either Group A--Grade III or IV, or Group B--Grade I-II, or no IVH. RESULTS: Neonates with Grade III/IV IVH had significantly lower plasma Factor VII (FVII) level on first day of life and FVII differed significantly between Groups A and B with sensitivity of 100%, specificity 41% for a cut-off value of< 7%. In Group A there was no improvement of prothrombin and activated partial thromboplastin times on Day 2. A significant decline of platelet count was also observed. CONCLUSIONS: High-grade IVH coincides with severe derangement of coagulation in ELBW infants with FVII level being the most sensitive, it is not clear what the reason for such low FVII concentration is. Further studies are indicated.

[Diagnostic value of thermography and endothelin concentration in serum of children with Raynaud's Syndrome]. / Wartosc diagnostyczna termowizji i oznaczania stezen endoteliny we krwi w diagnostyce Zespolu Raynaud u dzieci.

OBJECTIVE: The primary Raynaud's Syndrome may occur in pubescent children, the secondary is connected with connective tissue diseases. The aim of this study was to evaluate the diagnostic value of thermography and endothelin concentration in patients with Raynaud's Syndrome (RS). MATERIAL AND METHODS: 49 patients aged 11 to 18 years with clinical symptoms of RS and 12 healthy children participated in the study. 17 patients had secondary and 32 primary RS. Thermography was conducted in all children. Vasomotor disturbances were diagnosed by Doppler ultrasonography. Palm temperature measurements were taken in room temperature before, directly after the cooling test and 4 minutes later. ET-1 serum concentration was tested by ELISA. RESULTS: The mean palm temperatures after the cooling test were significantly lower than in control group. (26.28 +/- 3.13C vs 30.26 +/- 1.11C p<0.001). There was no difference between primary and secondary RS. After cooling, the palm temperatures were statistically lower than before the test in all children (primary RS -19.56 +/- 1.68; secondary RS -18.7 +/- 1.02; control group -- 18.98 +/- 0.39). The warming up speed of palm after 4 minutes from the cooling test was similar in investigated and control groups. There was no statistically significant difference in the mean concentration values of ET-1 in sera of children with RS and the control group (1.62 +/- 0.86 pg/ml vs 1.27 +/- 0.4 pg/ml). CONCLUSIONS: 1. Thermographic estimation of palm temperatures in children with RS is a good diagnostic method of vasomotor disturbances. 2. Assay of ET-1 serum levels seem not to have significant diagnostic value.