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Thromboelastography in term neonates: an alternative approach to evaluating coagulopathy
  1. Elizabeth K Sewell1,2,
  2. Katie R Forman1,2,3,
  3. Edward C C Wong4,5,
  4. Meanavy Gallagher4,
  5. Naomi L C Luban4,5,
  6. An N Massaro1,2
  1. 1Divisions of Neonatology, Children's National Health Systems, Washington DC, USA
  2. 2Departments of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
  3. 3Department of Neonatal-Perinatal Medicine, Children's Hospital of Montefiore, Bronx, New York, USA
  4. 4Divisions of Laboratory Medicine, Children's National Health Systems, Washington DC, USA
  5. 5Departments of Pathology, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
  1. Correspondence to Dr An N Massaro, Assistant Professor of Pediatrics, The GWU School of Medicine, Department of Neonatology, Children's National Medical Center, 111 Michigan Avenue, NW, Washington DC 20010, USA; anguyenm{at}childrensnational.org

Abstract

Objective To develop normative ranges for citrate-modified and heparinase-modified thromboelastography (TEG) in term neonates.

Design Prospective observational study.

Setting An outborn neonatal and cardiac intensive care unit in a free-standing academic children's hospital.

Patients Thirty term neonates were enrolled as control subjects. Seventeen infants with clinically documented bleeding requiring blood transfusion were enrolled in the comparison group.

Main outcome measures Citrate-modified and heparinase-modified TEG parameters were calculated from blood specimens drawn via peripheral arterial stick or arterial line.

Results TEG in neonates differs from older children and adults; clotting time (R) and clot kinetics (K) values are generally lower while fibrinolysis or rate of clot breakdown (LY30) and coagulation index (CI) are often higher in neonates. TEG values in term neonates calculated as median (Q1–Q3) are as follows: R 4.150 (3.200–6.200), K 1.550 (1.200–1.800), α angle (α) 70.100 (66.000–72.900), maximum amplitude (MA) 61.850 (59.400–66.000), LY30 1.050 (0.100–1.600) and CI 1.950 (0.100 to 2.900). Cut points selected for optimal predictive value for bleeding using receiver operating curve analyses were R>6.3 (sensitivity 82.4%, specificity 80%); K>2.5 (sensitivity 82.4%, specificity 96.7%); α<59 (sensitivity 82.4%, specificity 96.7%); MA<57 (sensitivity 82.4%, specificity 86.7%); CI<−0.15 (sensitivity 88.2%, specificity 83.3%).

Conclusions The reference ranges and cut points for citrate-modified and heparinase-modified TEG can be used to diagnose and evaluate coagulopathy in term neonates.

  • thromboelastography
  • neonate
  • coagulation
  • reference range

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