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

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Abstract

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.

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Abbreviations

A5, A10:

Amplitude recorded at 5 and 10 min

AGA:

Appropriate for gestational age

a°:

a angle

APCR:

Activated protein C resistance

aPTT:

Activated partial thromboplastin time

AT-III:

Antithrombin III

CFT:

Clot formation time

CT:

Clotting time

DOL:

Day of life

ex-TEM:

Extrinsically activated TEM

GA:

Gestational age

INR:

International normalized ratio

IQR:

Interquartile ranges

LI60%:

Lysis index at 60 min

MCF:

Maximum clot firmness

nCPAP:

Nasal continuous positive airway pressure

NICU:

Neonatal Intensive Care Unit

PAI-1:

Plasminogen activator inhibitor-1

PEEP:

Pressure positive end-expiratory pressure

POC:

Point-of-care

PT:

Prothrombin time

SGA:

Small for gestational age

TEG:

Thromboelastography

TEM:

Thromboelastometry

tPA:

Tissue plasminogen activator

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Author information

Author notes

  1. Rozeta Sokou and Aikaterini Konstantinidi contributed equally to this work.

Authors and Affiliations

  1. Neonatal Intensive Care Unit, Nikaia General Hospital “Aghios Panteleimon”, Piraeus, Greece

    Rozeta Sokou, Aikaterini Konstantinidi, Charikleia Stefanaki, Stavroula Parastatidou, Katerina Lampropoulou, George Katsaras & Evagelia Tavoulari

  2. Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Andreas G. Tsantes, Elias Kyriakou & Argirios E. Tsantes

  3. Neonatal Department, Aretaeio Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Nicoletta Iacovidou

  4. Neonatal Intensive Care Unit, University Hospital of Larissa, Larissa, Greece

    Antonios Gounaris

  5. Department of Biomedical Sciences, Humanitas University, Milan, Italy

    Stefanos Bonovas

  6. Humanitas Clinical and Research Center, Milan, Italy

    Stefanos Bonovas

Authors
  1. Rozeta Sokou
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  2. Aikaterini Konstantinidi
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  3. Charikleia Stefanaki
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  4. Andreas G. Tsantes
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  5. Stavroula Parastatidou
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  6. Katerina Lampropoulou
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  7. George Katsaras
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  9. Nicoletta Iacovidou
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  10. Elias Kyriakou
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  11. Antonios Gounaris
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  12. Stefanos Bonovas
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  13. Argirios E. Tsantes
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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.

Corresponding author

Correspondence to Rozeta Sokou.

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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).

Additional information

Communicated by Patrick Van Reempts

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Sokou, R., Konstantinidi, A., Stefanaki, C. et al. Thromboelastometry: studying hemostatic profile in small for gestational age neonates—a pilot observational study. Eur J Pediatr 178, 551–557 (2019). https://doi.org/10.1007/s00431-019-03331-w

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  • DOI: https://doi.org/10.1007/s00431-019-03331-w

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