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Fresh-Frozen Plasma as a Source of Exogenous Insulin-Like Growth Factor-I in the Extremely Preterm Infant

Division of Pediatrics (I.H-.P., A.-C.B., V.F., D.L.), Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden; Department of Pediatrics (E.E., A.N.), Institute of Clinical Sciences, and Department of Ophthalmology (C.L., A.H.), Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, SE-413 45 Göteborg, Sweden; and Department of Pediatrics (V.F.), University of Helsinki, 00170 Helsinki, Finland

Address all correspondence and requests for reprints to: Ingrid Hansen-Pupp, M.D., Ph.D., Division of Pediatrics, Department of Clinical Sciences, Lund, Lund University Hospital, 221 85 Lund, Sweden. E-mail: ingrid.pupp{at}skane.se.

Context: Preterm birth is followed by a decrease in circulatory levels of IGF-I and IGF binding protein (IGFBP)-3, proteins with important neurogenic and angiogenic properties.

Objective: Our objective was to evaluate the effects of iv administration of fresh-frozen plasma (FFP) from adult donors on circulatory levels of IGF-I and IGFBP-3 in extremely preterm infants.

Design, Setting, and Patients: A prospective cohort study was performed in 20 extremely preterm infants [mean (SD) gestational age 25.3 (1.3) wk] with clinical requirement of FFP during the first postnatal week. Sampling was performed before initiation of transfusion, directly after, and at 6, 12, 24, and 48 h after completed FFP transfusion.

Main Outcome Measures: Concentrations of IGF-I and IGFBP-3 before and after transfusion of FFP were determined.

Results: FFP with a mean (SD) volume of 11 ml/kg (3.1) was administered at a median postnatal age of 2 d (range 1–7). Mean (SD) IGF-I and IGFBP-3 concentrations in administered FFP were 130 (39) and 2840 µg/liter (615), respectively. Immediately after FFP transfusion, mean (SD) concentrations of IGF-I increased by 133% from 11 (6.4) to 25 µg/liter (9.3) (P < 0.001) and IGFBP-3 by 61% from 815 (451) to 1311 µg/liter (508) (P < 0.001). Concentrations of IGF-I and IGFBP-3 remained higher at 6 (P < 0.001, P = 0.009) and 12 h (P = 0.017, P = 0.018), respectively, as compared with concentrations before FFP transfusion. Typical half-life of administrated IGF-I was 3.4 h for a 1-kg infant.

Conclusion: Transfusion of FFP to extremely preterm infants during the first postnatal week elevates levels of IGF-I and IGFBP-3.