Faculty Collaboration Database

The initial experience of antithrombin III in the management of neonates with necrotizing enterocolitis. J Pediatr Surg 2007 Apr;42(4):704-8

Date

04/24/2007

Pubmed ID

17448770

DOI

10.1016/j.jpedsurg.2006.12.018

Scopus ID

2-s2.0-34247169575 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

BACKGROUND: Necrotizing enterocolitis (NEC), the devastating enteric process of premature neonates, is marked by severe intravascular abnormalities and disseminated intravascular coagulation. Treatment to date remains historical and continues to be merely supportive without attempts to ameliorate progress within the inflammatory or coagulation cascades. Antithrombin III (ATIII) supplementation has been shown to favorably alter the process of disseminated intravascular coagulation and sepsis in adults. However, no reported use of this treatment exists in neonates. Therefore, we analyze the efficacy of our recent experience with ATIII replacement therapy in neonates with NEC.

METHODS: Age and diseased-matched controls with NEC were identified before the introduction of ATIII in our institution and compared against neonates with NEC undergoing ATIII replacement for diminished ATIII levels. Data collected included demographics, course of treatment parameters, and outcomes. Course of treatment parameters included hemoglobin, platelet count, prothrombin time, and partial thromboplastin time over the first 10 consecutive days of treatment. Outcome variables included packed red blood cell, platelet, fresh frozen plasma, and cryoprecipitate transfusions, as well as transfusion cost, length of stay, and survival.

RESULTS: Over a 5-year period, 19 neonates with NEC received ATIII and were compared to 17 historical controls. Treatment hematologic profiles were not worsened in the ATIII-treated patients. The control patients received less overall transfusions and had a shorter length of stay.

CONCLUSION: Antithrombin III appears to be safe in neonates with NEC, and its impact on reversing intravascular pathology in these patients warrants more thorough investigation.

Author List

St Peter SD, Little DC, Calkins CM, Holcomb GW 3rd, Snyder CL, Ostlie DJ

Author

Casey Matthew Calkins MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anticoagulants
Antithrombin III
Blood Transfusion
Disseminated Intravascular Coagulation
Enterocolitis, Necrotizing
Female
Humans
Infant, Newborn
Male