Bleeding Problems in Extremely Low Birth Weight Neonates: Quick (and Wintrobe) Thinking Needed

Bleeding complications occur all too commonly among extremely low birth weight (ELBW) neonates. Although sometimes the bleeding is minimal and transient, some hemorrhages are life-altering or life-ending events. Compared with term neonates, ELBW neonates typically have lower platelet counts, reduced platelet function (when measured with in vitro testing), and prolonged coagulation times. These laboratory findings have led to attempts to “correct” the “immature” hemostatic systems of ELBW neonates by prophylactically transfusing adult donor platelets and/or adult plasma to nonbleeding neonates in the hope of reducing their bleeding risk. Although well-meaning and consistent with laboratory normal values, this approach has been ineffectual. In this review, we seek to teach basic philosophies used by 2 pioneers of hematology, Drs Quick and Wintrobe. We apply their principles to the population of ELBW infants. We also review practical steps that neonatologists can take to reduce the risk of hemorrhagic problems, particularly intracranial hemorrhages, that occur in ELBW neonates.