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Thromb Haemost 2010; 103(02): 344-350
DOI: 10.1160/TH09-05-0282
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Clot formation of neonates tested by thromboelastography correlates with gestational age

Tzipi Strauss
1   Neonatolgy, National Hemophilia Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
3   Thrombosis Unit, National Hemophilia Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
,
Yael Levy-Shraga
2   Pediatric Hematoloy, Safra Medical Center for Children, National Hemophilia Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
,
Bruria Ravid
3   Thrombosis Unit, National Hemophilia Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
,
Irit Schushan-Eisen
1   Neonatolgy, National Hemophilia Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
,
Ayala Maayan-Metzger
1   Neonatolgy, National Hemophilia Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
,
Jacob Kuint
1   Neonatolgy, National Hemophilia Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
,
Gili Kenet
3   Thrombosis Unit, National Hemophilia Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
› Author Affiliations
Further Information

Publication History

Received: 05 May 2009

Accepted after major revision: 10 January 2009

Publication Date:
22 November 2017 (online)

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Summary

Evaluation of clot formation in neonates is troublesome. Our aim was to investigate cord blood clot formation of pre-term versus full-term infants and adults, using rotating thromboelastogram (ROTEM®, Pentafarm, Munich, Germany). ROTEM was investigated in cord blood of 184 full-term and 47 pre-term infants. Measurements of the clotting time (CT), clot formation time (CFT) and maximal clot firmness (MCF) were obtained in order to asses reference values for this age group, and compare between full-term and pre-term neonates and compared to adult controls. For each infant demographic information and data regarding pregnancy and delivery were gathered. Infants were prospectively followed until discharge. CT and CFT were significantly shorter among pre-term and term infants as compared to adults [median CT: 185, 194, 293 seconds respectively, p≤0.001, CFT: 80, 76, 103 seconds respectively, p≤0.001). MCF was lower in pre-term and term as compared to adults (p≤0.001) with significantly lower values in pre-term as compared to full-term neonates (p=0.004). Clotting time and MCF correlated with gestational age (R=0.132, p=0.045, R= 0.259, p<0.001, respectively). No association was found between any ROTEM values and the occurrence of post-natal complications in infants of our study group. This is the first study assessing clot formation by ROTEM in pre-term infants. Clot formation parameters of term and premature infants correlated with gestational age. The predictive value of clot formation tests in neonates deserves further attention.

Keywords

Neonates - preterm - coagulation - thromboelastography - ROTEM
 

  • References

  • 1 Reverdiau-Moalic P, Delahousse B, Bardos P. et al. Evolution of blood coagula -tion activators and inhibitors in the healthy human fetus. Blood 1996; 88: 900-906.
    PubMedGoogle Scholar
  • 2 Andrew M, Vegh P, Johnston M. et al. Maturation of the hemostatic system during childhood. Blood 1992; 80: 1998-2005.
    PubMedGoogle Scholar
  • 3 Cvirn G, Gallistl S, Muntean W. Effects of antithrombin and protein C on thrombin generation in newborn and adult plasma. Thromb Res 1999; 93: 183-190.
    CrossrefPubMedGoogle Scholar
  • 4 Andrew M, Schmidt B, Mitchell L. et al. Thrombin generation in newborn plasma is critically dependant on the concentration of prothrombin. Thromb Haemost 1990; 63: 27-30.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Summaria L. Comparison of human normal, full-term, fetal and adult plasminogen by physical and chemical analyses. Haemostasis 1989; 19: 266-273.
    PubMedGoogle Scholar
  • 6 Monagle P, Barnes C, Ignjatovic V. et al. Developmental haemostasis. Impact for clinical haemostasis laboratories. Thromb Haemost 2006; 95: 362-372.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Hermansen MC. Nucleated red blood cells in the fetus and newborn. Arch Dis Child Fetal Neonatal Ed 2001; 84: F211-215.
    CrossrefPubMedGoogle Scholar
  • 8 Katz JA, Moake JL, McPherson PD. et al. Relationship between human development and disappearance of unusually large von Willebrand factor multimers from plasma. Blood 1989; 73: 1851-1858.
    CrossrefPubMedGoogle Scholar
  • 9 Del Vecchio A, Latini G, Henry E, Christensen RD. Template bleeding time of 240 neonates born at 24 to 41 weeks gestation. J Perinatol 2008; 28: 427-423.
    CrossrefPubMedGoogle Scholar
  • 10 Saxonhouse MA, Sola MC. Platelet function in term and preterm neonates. Clin Perinatol 2004; 31: 15-18.
    CrossrefPubMedGoogle Scholar
  • 11 Levy-Shraga Y, Maayan-Metzger A, Lubetsky A. et al. Platelet function of newborns as tested by the Cone and Plate(let) analyser correlates with gestational age. Acts Haematol 2006; 115: 152-156.
    PubMedGoogle Scholar
  • 12 Whitten CW, Greilich PE. Thromboelastography: past, present,and future. Anesthesiology 2000; 92: 1223-1225.
    CrossrefPubMedGoogle Scholar
  • 13 Rivard GE, Brummel-Ziedins KE, Mann KG. et al. Evaluation of the profile of thrombin generation during the process of whole blood clotting as assessed by thrombelastography. J Thromb Haemost 2005; 3: 2039-2043.
    CrossrefPubMedGoogle Scholar
  • 14 Jackson GN, Ashpole KJ, Yentis SM. The TEG vs the ROTEM thromboelastography/thromboelastometry systems. Anaesthesia 2009; 64: 212-215.
    CrossrefPubMedGoogle Scholar
  • 15 Miller BE, Guzzetta NA, Tosone TR. et al. Tissue factor-activated thromboelasto-grams in children undergoing cardiac surgery: Baseline values and comparisons. Anesth Analg 2003; 97: 1289-1293.
    PubMedGoogle Scholar
  • 16 Davidson SJ, McGrowder D, Roughton M. et al. Can ROTEM thromboelastometry predict postoperative bleeding after cardiac surgery. J Cardiothorac Vasc Anesth 2008; 22: 655-661.
    CrossrefPubMedGoogle Scholar
  • 17 Chan AKC, Leaker M, Burrows FA. et al. Coagulation and fibrinolytic profile of paediatric patients undergoing cardiopulmonary bypass. Thomb Haemost 1997; 77: 270-277.
    PubMedGoogle Scholar
  • 18 Kern FH, Morana NJ, Sears JJ. et al. Coagulation defects in neonates during cardiopulmonary bypass. Ann Thorac Surg 1992; 54: 541-546.
    CrossrefPubMedGoogle Scholar
  • 19 Haizinger B, Gombotz H, Rehak P G.. et al. Activated thrombelastogram in neonates and infants with complex congenital heart disease in comparison with healthy children. Br J Anaesth 2006; 97: 545-552.
    CrossrefPubMedGoogle Scholar
  • 20 Koh MBC, Hunt BJ. The management of perioperative bleeding. Blood Rev 2003; 17: 179-185.
    CrossrefPubMedGoogle Scholar
  • 21 Miller BE, Tosone SR, Guzetta NA. et al. Fibrinogen in children undergoing cardiac surgery: Is it effective?. Anesth Analg 2004; 99: 1341-1346.
    PubMedGoogle Scholar
  • 22 Miller BE, Guzetta NA, Tosone SR. et al. Rapid evaluation of coagulopathies after cardiopulmonary bypass in children using modified thromboelastography. Anesth Analg 2000; 90: 1324-1330.
    CrossrefPubMedGoogle Scholar
  • 23 Cammerer U, Dietrich W, Rampf T. et al. The predictive value of modified computerized thromboelastography and platelet function analysis for postoperative blood loss in routine cardiac surgery. Anesth Analg 2003; 96: 51-57.
    PubMedGoogle Scholar
  • 24 Rajasekhar D, Barnard M, Francis J. et al. Platelet hyporeactivity in very low birth weight neonates. Thromb Haemost 1997; 77: 1002-1007.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Cvirn G, Gruber HJ, Koestenberger M. et al. High availability of intravascular tissue factor in neonates. J Pediatr Hematol Oncol 2007; 29: 279-283.
    CrossrefPubMedGoogle Scholar
  • 26 Kettner SC, Pollak A, Zimpfer M. et al. Heparinase-modified thrombelastography in term and preterm neonates. Anesth Analg 2004; 98: 1650-1652.
    PubMedGoogle Scholar
  • 27 Wiedmeier SE, Henry E, Sola-Visner MC. et al. Platelet reference ranges for neonates, de?ned using data from over 47 000 patients in a multihospital healthcare system. J Perinatol 2009; 29: 130-136.
    CrossrefPubMedGoogle Scholar
  • 28 Aronis S, Platokouli H, Photopoulos S. et al. Indications of coagulation and/or fibrinolytic system activation in healthy and sick very low birth weight infants. Biol Neonate 1998; 74: 337-344.
    CrossrefPubMedGoogle Scholar
  • 29 Kulkarni R, Lusher J. Intracranial and extracranial hemorrhages in newborns with hemophilia:a review of the literature. J Pediatr Hematol Oncol 1999; 21: 289-295.
    CrossrefPubMedGoogle Scholar
  • 30 Gleissner M, Jorch G, Avenarius S. Risk factors for intraventricular hemorhage in a birth cohort of 3721 premature infants. J Perinat Med 2000; 28: 104-110.
    PubMedGoogle Scholar
  • 31 Salonvaara M, Riikonen P, Kekomaki R. et al. Intraventricular haemorrhage in very-low-birthweight preterm infants: Association with low prothrombin activity at birth. Acta Paediatr 2005; 94: 807-811.
    CrossrefPubMedGoogle Scholar