Abstract
Background: Sick preterm infants have low levels of antithrombin (AT). It has been hypothesised that prophylactic administration of AT would prevent intraventricular haemorrhage (IVH).
Method: We conducted a systematic review and meta-analysis of randomised, controlled trials that compared any dose of AT with placebo or no treatment, in preterm infants. This systematic review was conducted using the methods of the Cochrane Collaboration. Data were extracted from the published papers/abstracts. When appropriate we combined data from different trials into a meta-analysis using a fixed-effects model.
Results: Three randomised trials, two published as full-text articles and one abstract, comprising 280 preterm infants, met our inclusion criteria. The mean gestational age, in the 2 full-text studies, was 28 weeks. The total dose of AT was comparable in these two studies, 500 U/Kg and 400 U/Kg, in divided doses over the first 48 hours of life. IVH was reported in all three trials; none of the individual trials found a significant statistical difference. The pooled analysis (from the 2 full-text trials) for any grade of IVH within the first week of life showed a relative risk that favoured the control group: RR 1.30 (95% CI 0.81 to 2.08). The trials did not report follow-up of IVH beyond 1 week. None of the individual trials demonstrated any significant difference in neonatal mortality. A pooled analysis of mortality in infants with no IVH at randomisation was not possible from the published data.
Conclusions: There is little evidence that prophylactic AT reduces IVH. We cannot recommend the use of prophylactic AT to prevent IVH in preterm infants.
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Millar, D., Bassler, D. & Schmidt, B. 248 Prophylactic Antithrombin to Prevent Intraventricular Haemorrhage in Preterm Infants: A Systematic Review.. Pediatr Res 58, 397 (2005). https://doi.org/10.1203/00006450-200508000-00277
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DOI: https://doi.org/10.1203/00006450-200508000-00277