Thrombomodulin Levels in Umbilical Cord Blood-derived Plasma between Light-for-Date and Appropriate-for-Date Infants

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Thrombomodulin, a thrombin receptor on the surface of endothelial cells, plays an important role not only in maintaining normal hemostatic balance but also in in utero development. Plasma thrombomodulin has been used in the clinical setting as a marker of endothelial damage in adults; however, the clinical values for neonates have not yet been determined. Intrauterine growth restriction has deleterious effects on mortality and morbidity in both term and preterm infants. The purpose of the present study was to examine whether or not the association between thrombomodulin and gestational age differed between appropriate-for-date (AFD) and light-for-date (LFD) infants. We measured the thrombomodulin levels in the umbilical cord bloodderived plasma of 388 neonates divided into LFD and AFD infants and analyzed their association with gestational age, birth weight, umbilical cord blood pH, and Apgar scores. The plasma thrombomodulin levels were higher in neonates than in adults. There was an inverse correlation between the gestational age and thrombomodulin levels in AFD infants; however, LFD infants presented high plasma thrombomodulin levels throughout the gestational ages examined. While plasma thrombomodulin levels correlated with gestational age and differed between LFD and AFD infants, no clear correlations were seen with Apgar scores, birth weight, cord blood pH or base excess in a multivariate analysis. While such high plasma thrombomodulin levels in preterm infants may reflect their normal physiological background, the difference between the AFD and LFD infants may be caused by pathological processes other than asphyxiation events in LFD infants.

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