Bleeding disorders in newborns: prevalence, risk factors and coagulation indices at Muhimbili Medical Centre, Dar-es Salaam, Tanzania.

Abstract

Neonatal bleeding disorders (NBD) are common causes of morbidity and mortality at the neonatal unit, Muhimbili medical centre, Dar Es Salaam. However, no study has yet been done to determine the magnitude or the associated risk factors. Therefore a descriptive cross-sectional and case control study was carried out from January 22nd to April 25th, 1998 to determine the prevalence and risk factors associated with NBD. During this period a total of 1628 newborn infants were admitted to the neonatal ward and out of ~ these 589 babies ~ recruited into the study. One hundred seventy five infants (29.9%) with bleeding disorders were recruited as cases and 414 (70.2%) without evidence of bleeding as controls. Only infants where parental consent was obtained were included into the study. For each infant a thorough history was taken, physical examination done and a full blood picture together with coagulation profile determined. Twin babies were 18 (10.3%) of the study cases as compared to 46 (11.1 %) in the controls. Singleton babies were 157 (89.7%) of the cases and 368 (88.9%) of the controls. The difference in bleeding status between twin and singleton infants was found not to be statistically significant (X2 =0.09, P = 0.76). Seventy nine (45.1 %) of the study cases and 148 (35.7%) of the control cases were born with Low Birth Weight (LBW). The difference was statistically significant (X2 = 4.58, P = 0.03). Furthermore 54 (30.9%) of the study cases and 95 (22.9%) of the controls were born prematurely and the' difference was statistically significant (X2 = 4.07, P = 0 .04). One hundred and eight (61.7%) of the cases and 199 (48.1%) of the controls were asphyxiated and the difference was highly significant (X2 = 9.18, P = 0.002). In 27 (31.4%) of the cases and 121 (54.8%) of the

III controls, the mother was given general anaesthesia during delivery. The difference was highly significant (X2 = 13.53, P = 0.0002). The APGAR score was less than 7 in 86 (49.1 %) of the cases and 124 (30%) of the controls. The difference was highly significant (X2 = 20.43 p = 0.00003). Fifty six (32%) of the study group and 166 (40.1 %) of the controls cases were delivered by a mode other than Spontaneous Vertex Delivery (SVD) and the difference was also highly significant (X2 = 30.97, p = 0.0000008). The Prothrombin Time (PT) was prolonged in 5 (2.9%) of the cases and 13 (3.4%) of the controls, but the difference was not statistically significant (X2 = 0.56, P = 0.7). The Activated Partial Thromboplastin Time (APTT) was also prolonged in 14 (8.1 %) of the cases and 33 (8.8%) of the controls. However, the difference was also not statistically significant (X2 =1.52, P = 0.46). The proportion of infants with vitamin-K deficiency ( crude prevalence) as judged by abnormal PT and APTT in the study population ranged between 2.9% to 8.8%, but the majority of them did not have any obvious bleeding clinically. The prevalence ofNBD was found to be 10.7% and that vitamin-K deficiency related bleeding was not a significant problem at the neonatal unit. However, large scale studies are needed to confirm this finding. Asphyxia neonatorum, LBW, mode of delivery other than SVD and general anaesthesia were the only risk factors significantly associated with bleeding.