Fresh-frozen Plasma as a Source of Exogenous Insulin-like Growth Factor I in the Extremely Preterm Infant.

Context: Preterm birth is followed by a decrease in circulatory levels of IGF-I and IGF binding protein-3 (IGFBP-3), proteins with important neurogenic and angiogenic properties. Objective: To evaluate effects of intravenous 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 performed in twenty extremely preterm infants (mean (SD) gestational age 25.3 (1.3) weeks) 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 48h after completed FFP transfusion. Main outcome measures: Concentrations of IGF-I and IGFBP-3 before and after transfusion of FFP. Results: FFP with a mean (SD) volume of 11 (3.1) ml/kg, was administered at a postnatal age of median (range) 2 (1-7) days. Mean (SD) IGF-I and IGFBP-3 concentrations in administered FFP were 130 (39) and 2840 (615) microg/L, respectively. Immediately after FFP transfusion, mean (SD) concentrations of IGF-I increased by 133% from 11 (6.4) to 25 (9.3) microg/L, p<0.001 and IGFBP-3 by 61% from 815 (451) to 1311 (508) microg/L, p<0.001. Concentrations of IGF-I and IGFBP-3 remained higher at 6 h, p<0.001, p=0.009 and at 12 h, p=0.017, p=0.018, respectively, as compared to 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.