Silent Struggles Beyond Breath: Decoding Hemostatic Dynamics and Bleeding in Neonates Affected by Perinatal Asphyxia

Abstract

Perinatal asphyxia, a prevalent neonatal challenge, induces significant hemodynamic perturbations leading to life-threatening bleeding. This study aimed to estimate the incidence of hemostatic dysfunction and characterize bleeding events in neonates with perinatal asphyxia. Secondary objectives included evaluating the relationship between specific components of hemostatic parameters and the severity of bleeding events, along with identifying parameters predicting abnormal bleeding. This observational study, spanning 20 months in the NICUs of S. M. S. Medical College and an attached group of hospitals in Jaipur, enrolled 110 neonates with perinatal asphyxia on whom hemostatic testing was done within 24 hours of birth. The presence of one or more of the following—platelet count < 1 lakh/mm³, PT > 20 seconds, INR > 1.5, aPTT > 45 seconds, and fibrinogen < 150 mg/dl—was defined as hemostatic dysfunction. Bleeding events were assessed for up to 96 hours using the Neonatal Bleeding Assessment Tool and graded by the WHO Bleeding Scale. Among 110 neonates, the incidence of initial hemostatic dysfunction was 70%. Fifty-one neonates (46.3%) experienced bleeding, among whom 5 (9.8%) had minor, 21 (41.18%) had moderate, 15 (29.42%) had major, and 10 (19.6%) had severe bleeding events. Forty-seven neonates (42.72%) received at least one blood product transfusion, with fresh frozen plasma (FFP) being the most common (100%). Neonates with perinatal asphyxia exhibit a high incidence of hemostatic dysfunction, signifying an elevated risk of bleeding and transfusion requirements. While routine hemostatic testing identifies dysfunction, predicting bleeding warrants a search for better investigations. This helps in establishing guidelines for early interventions, which is crucial to reduce mortality risks in these neonates.