The initial experience of antithrombin III in the management of neonates with necrotizing enterocolitis.
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.
Journal of pediatric surgery
Anticoagulants; Antithrombin III; Blood Transfusion; Disseminated Intravascular Coagulation; Enterocolitis, Necrotizing; Female; Humans; Infant, Newborn; Male
Necrotizing enterocolitis: NEC
St Peter, S. D., Little, D. C., Calkins, C. M., Holcomb, G. W., Snyder, C. L., Ostlie, D. J. The initial experience of antithrombin III in the management of neonates with necrotizing enterocolitis. Journal of pediatric surgery 42, 704-708 (2007).