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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}


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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  • Contributors ANM conceptualised and designed the study, coordinated and supervised data collection, performed data analyses, revised the manuscript and approved the final manuscript as submitted. EKS performed the bulk of data collection and management, and wrote the first draft of the manuscript. KRF, EW, NLCL and MG provided substantial contributions to conception and design, and/or analysis and interpretation of data, made contributions to drafting of article or revising it critically for important intellectual content and approved the final version to be submitted.

  • Funding This project was financially supported by The Haemonetics Corporation.

  • Competing interests None declared.

  • Ethics approval Children’s National Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data summarised in this article will be made available upon request to the authors.