Thromboelastometry: studying hemostatic profile in small for gestational age neonates—a pilot observational study

  • Rozeta SokouEmail author
  • Aikaterini Konstantinidi
  • Charikleia Stefanaki
  • Andreas G. Tsantes
  • Stavroula Parastatidou
  • Katerina Lampropoulou
  • George Katsaras
  • Evagelia Tavoulari
  • Nicoletta Iacovidou
  • Elias Kyriakou
  • Antonios Gounaris
  • Stefanos Bonovas
  • Argirios E. Tsantes
Original Article


Scarce data exists about the hemostatic status of small for gestational age (SGA) neonates. We aimed at evaluating the hemostatic profile of SGA neonates, using thromboelastometry (TEM). This is an observational study performed in a Greek tertiary General Hospital during an 18-month period. Ninety-three neonates were included in the study: 48 appropriate for gestational age weight (AGA) neonates and 45 SGA neonates Extrinsically activated TEM (ex-TEM) parameters, such as clotting time, clot formation time, amplitude recorded at 5 and 10 min, a angle, maximum clot firmness, lysis index at 60 min, and also platelet count, were used for the evaluation of the hemostatic profile in all neonates. No statistically significant differences were noticed regarding all ex-TEM parameters between AGA and SGA neonates, while no event of hemorrhage or thrombosis was noticed in the study population.

Conclusions: The coagulation system of SGA neonates seems to be fully functional, with no evident tendency toward coagulopathy or thrombosis, when compared with AGA neonates. TEM seems to provide a promising and valid assessment of coagulation and fibrinolysis systems and may be used as a valuable biomarker, in the future. Further studies, with large samples, are necessary to confirm our results.

What is Known:

SGA neonates may present coagulation disorders mainly due to hepatic dysfunction, polycythemia, and thrombocytopenia owing to long-term intrauterine hypoxia.

In the literature, despite the statistically significant differences in laboratory results between SGA and AGA neonates, no clinical manifestations of significantly altered hemostasis were recorded. Data of TEM interpretation of hemostasis in SGA neonates are not available.

What is New:

TEM seems to interpret coagulation mechanism of preterm and full-term SGA neonates and confirm previous relevant literature findings regarding hemostasis in these neonates.


Hemostasis SGA neonates Thromboelastometry Coagulation system Coagulation disorders 


A5, A10

Amplitude recorded at 5 and 10 min


Appropriate for gestational age

a angle


Activated protein C resistance


Activated partial thromboplastin time


Antithrombin III


Clot formation time


Clotting time


Day of life


Extrinsically activated TEM


Gestational age


International normalized ratio


Interquartile ranges


Lysis index at 60 min


Maximum clot firmness


Nasal continuous positive airway pressure


Neonatal Intensive Care Unit


Plasminogen activator inhibitor-1


Pressure positive end-expiratory pressure




Prothrombin time


Small for gestational age






Tissue plasminogen activator


Authors’ contributions

RS, AK, and AT contributed to the conception and design of the study. RS, AK, SP, KL, GK, EK, and ET conducted the work and collected the data. A.G.T, AK, CS, RS, and SB carried out the statistical analysis. All authors contributed to the interpretation of data for the work. RS, AK, AT, SP, NI, AG, and SB drafted the manuscript. All authors critically revised the paper for important intellectual content and approved the final version to be published.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

For this type of study, formal consent is not required.

Ethical approval

The study was conducted in agreement with the Helsinki Declaration. Ethical approval was obtained from the Research Ethics Committee of the General Hospital of Nikaia-Piraeus Aghios Panteleimon (15.07.2014, 32/3).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Rozeta Sokou
    • 1
    Email author
  • Aikaterini Konstantinidi
    • 1
  • Charikleia Stefanaki
    • 1
  • Andreas G. Tsantes
    • 2
  • Stavroula Parastatidou
    • 1
  • Katerina Lampropoulou
    • 1
  • George Katsaras
    • 1
  • Evagelia Tavoulari
    • 1
  • Nicoletta Iacovidou
    • 3
  • Elias Kyriakou
    • 2
  • Antonios Gounaris
    • 4
  • Stefanos Bonovas
    • 5
    • 6
  • Argirios E. Tsantes
    • 2
  1. 1.Neonatal Intensive Care UnitNikaia General Hospital “Aghios Panteleimon”PiraeusGreece
  2. 2.Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of MedicineNational and Kapodistrian University of AthensAthensGreece
  3. 3.Neonatal Department, Aretaeio HospitalNational and Kapodistrian University of AthensAthensGreece
  4. 4.Neonatal Intensive Care UnitUniversity Hospital of LarissaLarissaGreece
  5. 5.Department of Biomedical SciencesHumanitas UniversityMilanItaly
  6. 6.Humanitas Clinical and Research CenterMilanItaly

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