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Risk factors associated with intracranial hemorrhage in neonates with persistent pulmonary hypertension on ECMO

BACKGROUND: Up to 40% of infants with persistent pulmonary hypertension (PPHN) remains refractory to conventional therapies, and extracorporeal membrane oxygenation (ECMO) is offered as an effective support for this group. However, ECMO is a highly invasive and risky procedure with devastating compl...

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Autores principales: Doymaz, Sule, Zinger, Marcia, Sweberg, Todd
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336126/
https://www.ncbi.nlm.nih.gov/pubmed/25705431
http://dx.doi.org/10.1186/s40560-015-0071-x
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author Doymaz, Sule
Zinger, Marcia
Sweberg, Todd
author_facet Doymaz, Sule
Zinger, Marcia
Sweberg, Todd
author_sort Doymaz, Sule
collection PubMed
description BACKGROUND: Up to 40% of infants with persistent pulmonary hypertension (PPHN) remains refractory to conventional therapies, and extracorporeal membrane oxygenation (ECMO) is offered as an effective support for this group. However, ECMO is a highly invasive and risky procedure with devastating complications such as intracranial hemorrhage (ICH). In this study, we aimed to determine the risk factors for ICH in infants with PPHN. METHODS: A case-control study of patients admitted to the pediatric intensive care unit (PICU) with PPHN requiring ECMO support was conducted. The study was carried out at a 25-bed PICU in large urban tertiary care children’s hospital. A total number of 32 subjects were studied. Patients with and without ICH during ECMO were evaluated for activated clotting time (ACT), heparin dosing, platelet count, coagulation profile such as activated partial thromboplastin time (aPTT), prothrombin time (PT), international normalized ratio (INR), fibrinogen level, vital signs including heart rate and mean arterial pressure (MAP), transfusion history, gestational age, and severity of pre-ECMO illness as possible risk factors. RESULTS: Low fibrinogen level (115 ± 13 mg/dl) and low platelet counts (37.4 ± 18.3 Thousand/μl) were associated with higher incidence of ICH (p = 0.009 and p = 0.005, respectively). Elevated MAP (69 ± 4.34 mmHg) was also noticed in ICH patients (p = 0.006). CONCLUSIONS: Results demonstrated that low fibrinogen level and low platelet count were associated with ICH in PPHN patients on ECMO. While on ECMO support, maintaining fibrinogen and platelet counts within normal ranges seems crucial to prevent ICH in PPHN patients. This is the first report identifying low fibrinogen level among the risk factors for ICH in infants with PPHN on ECMO support.
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spelling pubmed-43361262015-02-21 Risk factors associated with intracranial hemorrhage in neonates with persistent pulmonary hypertension on ECMO Doymaz, Sule Zinger, Marcia Sweberg, Todd J Intensive Care Research BACKGROUND: Up to 40% of infants with persistent pulmonary hypertension (PPHN) remains refractory to conventional therapies, and extracorporeal membrane oxygenation (ECMO) is offered as an effective support for this group. However, ECMO is a highly invasive and risky procedure with devastating complications such as intracranial hemorrhage (ICH). In this study, we aimed to determine the risk factors for ICH in infants with PPHN. METHODS: A case-control study of patients admitted to the pediatric intensive care unit (PICU) with PPHN requiring ECMO support was conducted. The study was carried out at a 25-bed PICU in large urban tertiary care children’s hospital. A total number of 32 subjects were studied. Patients with and without ICH during ECMO were evaluated for activated clotting time (ACT), heparin dosing, platelet count, coagulation profile such as activated partial thromboplastin time (aPTT), prothrombin time (PT), international normalized ratio (INR), fibrinogen level, vital signs including heart rate and mean arterial pressure (MAP), transfusion history, gestational age, and severity of pre-ECMO illness as possible risk factors. RESULTS: Low fibrinogen level (115 ± 13 mg/dl) and low platelet counts (37.4 ± 18.3 Thousand/μl) were associated with higher incidence of ICH (p = 0.009 and p = 0.005, respectively). Elevated MAP (69 ± 4.34 mmHg) was also noticed in ICH patients (p = 0.006). CONCLUSIONS: Results demonstrated that low fibrinogen level and low platelet count were associated with ICH in PPHN patients on ECMO. While on ECMO support, maintaining fibrinogen and platelet counts within normal ranges seems crucial to prevent ICH in PPHN patients. This is the first report identifying low fibrinogen level among the risk factors for ICH in infants with PPHN on ECMO support. BioMed Central 2015-02-11 /pmc/articles/PMC4336126/ /pubmed/25705431 http://dx.doi.org/10.1186/s40560-015-0071-x Text en © Doymaz et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Doymaz, Sule
Zinger, Marcia
Sweberg, Todd
Risk factors associated with intracranial hemorrhage in neonates with persistent pulmonary hypertension on ECMO
title Risk factors associated with intracranial hemorrhage in neonates with persistent pulmonary hypertension on ECMO
title_full Risk factors associated with intracranial hemorrhage in neonates with persistent pulmonary hypertension on ECMO
title_fullStr Risk factors associated with intracranial hemorrhage in neonates with persistent pulmonary hypertension on ECMO
title_full_unstemmed Risk factors associated with intracranial hemorrhage in neonates with persistent pulmonary hypertension on ECMO
title_short Risk factors associated with intracranial hemorrhage in neonates with persistent pulmonary hypertension on ECMO
title_sort risk factors associated with intracranial hemorrhage in neonates with persistent pulmonary hypertension on ecmo
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336126/
https://www.ncbi.nlm.nih.gov/pubmed/25705431
http://dx.doi.org/10.1186/s40560-015-0071-x
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