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39. Fibrinolytic system in infants of low birth weight and/or short gestational period

The aims of this investigation were: (1) to study fibrinolytic activity and the development of the different factors of the fibrinolytic system from early “prematurity” up to term and (2) to study the changes, if any, of these factors in ifants with postnatal asphyxia, idiopathic respiratory distress syndrome (IRDS), and intracranial hemorrhages. The material consisted of 197 infants in the 25th to 43rd gestational week. Approximately half of the material served as a “control material” to the rest of the infants with postnatal asphyxia and IRDS. Blood was obtained from a catheter in the umbilical artery or vein. Serial sampling was performed in one part of the material. Determinations were made of: fibrinolytic activity on fibrin plates, fibrinolytic split products (FSP) in serum and in serum with addition of ϵ-aminocaproic acid (EACA), fibrinogen, plasminogen, antiplasmin, α2-macrogtobulin, inhibitors of urokinase activation of plasminogen. Plasminogen and α2-macroglobulin increased significantly with increasing length of gestation, while the other factors were at the same levels as in full term newborns throughout. Fibrinolytic activity was demonstrated even in the smallest infants and also in infants which developed IRDS. It was high in some infants with severe hypoxia. FSP in serum-EACA were studied by serial sampling and were found in infants with severe hypoxia and acidosis. The various factors of the fibrinolytic system are sufficiently developed in preterm infants which are capable of producing fibrinolytic activity. The findings argue against the assumption that IRDS is due to a primary deficiency of the fibrinolytic system. It rather lends support to the hypothesis of an increased fibrinolysis in infants with hypoxia and acidosis.