Changes in thrombus formation and fibrinolysis indices, phosphorus-calcium metabolism and bone remodeling markers in the pathogenesis of cephalohematomas in newborns

Abstract

Long-term resorption of cephalohematoma in newborns may be accompanied by the development of osteogenic complications of the calvarial bones. The rate of resorption of cephalohematoma and the outcome of long-term persistence of subperiosteal hemorrhage are uncertain. It can be assumed that pathogenetic factors contributing to the development of osteogenic complications may be disturbances in the hemostasis system and bone tissue metabolism.

Aim. To define the level of indicators of thrombus formation and fibrinolysis, phosphorus-calcium metabolism and markers of bone tissue remodeling in venous blood in newborns with cephalohematomas, to assess the dynamics of bone changes in the cranial vault in the projection of subperiosteal hemorrhage.

Methods. There were 90 newborns under observation, 30 with medium and large cephalohematomas (the cephalohematoma was punctured), 30 with small cephalohematomas (the puncture was not performed) and 30 healthy newborns. In newborns, the level of tissue factor, prothrombin, antithrombin III, plasminogen, plasminogen activator and inhibitor, D-dimer, total calcium, inorganic phosphorus, alkaline phosphatase level, parathyroid hormone, vitamin D, as well as bone remodeling markers b-CrossLaps and osteocalcin. Measurement of local deformation of the calvarial bones was performed using ultrasonography and craniometry.

Results. It was found that the concentration of antithrombin III and type 1 plasminogen activation inhibitor in the blood plasma of all patients with cephalohematomas exceeded the indicators of the control group on the 10th and 28th days of the study. A decrease in the level of total calcium was revealed with a predominance of osteolytic changes in the skull bones in the projection of subperiosteal hemorrhage and the absence of a compensatory increase in the secretion of parathyroid hormone in patients with medium and large cephalohematomas on the 10th and 28th days of observation. At the same time, the processes of early ossification prevailed in patients with a small cephalohematoma and were accompanied by a more pronounced increase in the concentration of b-CrossLaps and osteocalcin.

Conclusion. The rate of resorption of subperiosteal hemorrhage depends on the fibrinolytic activity of the hemostatic system and factors influencing the rate of fibrinolysis. The reparative process for cephalohematomas in newborns is accompanied by pathological restructuring of bone tissue in the projection of hemorrhage and is associated with calcium metabolism.