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Template bleeding times of 240 neonates born at 24 to 41 weeks gestation

Journal of Perinatology volume 28, pages 427–431 (2008)Cite this article

Abstract

Objective:

The template bleeding time is a test used to assess the hemostatic effectiveness of platelet/endothelial interactions. A modified template bleeding time, described over 15 years ago by Andrew et al., has been used to test this aspect of hemostasis in term and preterm infants, but questions remain regarding the effect of gestational age and postnatal age on results. The effect of the platelet count (platelets per microliter blood) and the circulating platelet mass (nl platelets per microliter blood) on the bleeding time of neonatal intensive care unit (NICU) patients also require better definition.

Study Design:

We measured template bleeding times on 240 neonates at Ospedale A Perrino, in Brindisi, Italy; studying groups of n=60 at the following gestational ages; <28 weeks, 29 to 32 weeks, 33 to 37 weeks and ⩾38 weeks. In each group of 60 neonates, 20 were studied on the first day after birth, 20 were studied on day 10 and 20 were studied on day 30. A multivariate analysis was performed to examine various associations with bleeding time.

Result:

Bleeding times, on the first day of life, were shorter as gestational age increased. Those born <33 weeks gestation had bleeding times about twice that of those ⩾38 weeks (P<0.001). Bleeding times tended to shorten between days 1 and 10. Little or no further shortening occurred between days 10 and 30, and by day 30 they were not statistically different between the various gestational age groups. No independent effect on bleeding time could be ascribed to gender, platelet count or circulating platelet mass, but independent effects were found for hematocrit (P<0.02) and gestational age (P<0.001).

Conclusion:

On the first day of life, preterm neonates have a longer bleeding time than do term neonates. By day of life 10, the bleeding times at all gestational ages are shorter and are indistinguishable on the basis of gestational age at birth. Additionally, since platelet counts as low as 110 000 per microliter did not prolong the bleeding time, we see no benefit of administering a platelet transfusion to a stable, nonbleeding, NICU patient with mild thrombocytopenia (platelet count 100 000 to 150 000 per microliter).

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References

  1. Del Vecchio A, Sola MC . Performing and interpreting the bleeding time in the neonatal intensive care unit. Clin Perinatol 2000; 27(3): 643–654.

    Article  CAS  Google Scholar 

  2. Del Vecchio A . Use of the bleeding time in the neonatal intensive care unit. Acta Paediatr Suppl 2002; 91(438): 82–86.

    Article  CAS  Google Scholar 

  3. Feusner JH . Normal and abnormal bleeding times in neonates and young children utilizing a fully standardized template technic. Am J Clin Pathol 1980; 74(1): 73–77.

    Article  CAS  Google Scholar 

  4. Andrew M, Castle V, Mitchell L, Paes B . Modified bleeding time in the infant. Am J Hematol 1989; 30(3): 190–191.

    Article  CAS  Google Scholar 

  5. Andrew M, Paes B, Bowker J, Vegh P . Evaluation of an automated bleeding time device in the newborn. Am J Hematol 1990; 35(4): 275–277.

    Article  CAS  Google Scholar 

  6. Sola MC, Del Vecchio A, Edwards TJ, Suttner D, Hutson AD, Christensen RD . The relationship between hematocrit and bleeding time in very low birth weight infants during the first week of life. J Perinatol 2001; 21(6): 368–371.

    Article  CAS  Google Scholar 

  7. Del Vecchio A, Sullivan SE, Christensen RD, Schibler K, Hutson AD, Chevuru SC et al. Indomethacin prolongs the bleeding time in neonates significantly more than ibuprofen. Pediatr Res 2002; 51: 446A.

    Google Scholar 

  8. Mammen EF, Comp PC, Gosselin R, Greenberg C, Hoots WK, Kessler CM et al. PFA-100 system: a new method for assessment of platelet dysfunction. Semin Thromb Hemost 1998; 24(2): 195–202.

    Article  CAS  Google Scholar 

  9. Ridefelt P, Egberg N, Hillarp A, Lethagen S, Tengborn L . New in vitro analysis tested: bleeding time is still the best method for evaluation of primary hemostasis. Lakartidningen 2001; 98(37): 3922–3924.

    CAS  PubMed  Google Scholar 

  10. Linder N, Haskin O, Levit O, Klinger G, Prince T, Naor N et al. Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study. Pediatrics 2003; 111: e590–e595.

    Article  Google Scholar 

  11. Amato M, Fauchere JC, Hermann Jr U . Coagulation abnormalities in low birth weight infants with peri-intraventricular hemorrhage. Neuropediatrics 1988; 19(3): 154–157.

    Article  CAS  Google Scholar 

  12. Setzer ES, Webb IB, Wassenaar JW, Reeder JD, Mehta PS, Eitzman DV . Platelet dysfunction and coagulopathy in intraventricular hemorrhage in the premature infant. J Pediatr 1982; 100(4): 599–605.

    Article  CAS  Google Scholar 

  13. Bonifacio L, Petrova A, Nanjundaswamy S, Mehta R . Thrombocytopenia related neonatal outcome in preterms. Indian J Pediatr 2007; 74(3): 269–274.

    Article  Google Scholar 

  14. Del Vecchio A, Sola MC, Theriaque DW, Hutson AD, Kao KJ, Wright D et al. Platelet transfusions in the neonatal intensive care unit: factors predicting which patients will require multiple transfusions. Transfusion 2001; 41(6): 803–808.

    Article  CAS  Google Scholar 

  15. Garcia MG, Duenas E, Sola MC, Hutson AD, Theriaque D, Christensen RD . Epidemiologic and outcome studies of patients who received platelet transfusions in the neonatal intensive care unit. J Perinatol 2001; 21(7): 415–420.

    Article  CAS  Google Scholar 

  16. Christensen RD, Henry E, Wiedmeier SE, Stoddard RA, Sola-Visner MC, Lambert DK et al. Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system. J Perinatol 2006; 26(6): 348–353.

    Article  CAS  Google Scholar 

  17. Baer VL, Lambert DK, Henry E, Snow GL, Sola-Visner MC, Christensen RD . Do platelet transfusions in the NICU adversely affect survival? Analysis of 1600 thrombocytopenic neonates in a multihospital healthcare system. J Perinatol 2007; 27: 790–796.

    Article  CAS  Google Scholar 

  18. Poterjoy BS, Sola-Visner M, Christensen RD, Su L, Josephson C . Platelet transfusion practices among neonatologists in the USA: results of a survey. Pediatr Res 2007; 61: 6315 (abst).

    Google Scholar 

  19. Federici AB, Castaman G, Franchini M, Morfini M, Zanon E, Coppola A et al. Clinical use of Haemate P in inherited von Willebrand's disease: a cohort study on 100 Italian patients. Haematologica 2007; 92: 944–951.

    Article  CAS  Google Scholar 

  20. Israels SJ, Rand ML, Michelson AD . Neonatal platelet function. Semin Thromb Hemost 2003; 29: 363–372.

    Article  CAS  Google Scholar 

  21. Corazza MS, Davis RF, Merritt TA, Bejar R, Cvetnic W . Prolonged bleeding time in preterm infants receiving indomethacin for patent ductus arteriosus. J Pediatr 1984; 105(2): 292–296.

    Article  CAS  Google Scholar 

  22. Fass RJ, Copelan EA, Brandt JT, Moeschberger ML, Ashton JJ . Platelet-mediated bleeding caused by broad-spectrum penicillins. J Infect Dis 1987; 155: 1242–1248.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank the NICU nurses, Well baby nursery nurses and outpatient pediatric nurses of the Ospedale A Perrino, Brindisi, Italy for their assistance with this study; Diane K Lambert, RN at Intermountain Healthcare for her help with data assembly and Dr Martha C Sola-Visner, Children's Hospital, Boston, MA, USA for her helpful discussions about this project.

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Authors and Affiliations

  1. Division of Neonatology, Ospedale A Perrino, Brindisi, Italy

    A Del Vecchio & G Latini

  2. Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, UT, USA

    E Henry & R D Christensen

  3. McKay-Dee Hospital Center, Ogden, UT, USA

    R D Christensen

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  1. A Del Vecchio
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  2. G Latini
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  3. E Henry
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  4. R D Christensen
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Correspondence to R D Christensen.

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Vecchio, A., Latini, G., Henry, E. et al. Template bleeding times of 240 neonates born at 24 to 41 weeks gestation. J Perinatol 28, 427–431 (2008). https://doi.org/10.1038/jp.2008.10

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