Thromboelastography in term neonates: An alternative approach to evaluating coagulopathy

Elizabeth K. Sewell, Katie Rae Forman, Edward C C Wong, Meanavy Gallagher, Naomi L C Luban, An N. Massaro

Research output: Contribution to journalArticle

15 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)F79-F84
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
Volume102
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Thrombelastography
Heparin Lyase
Newborn Infant
Sensitivity and Specificity
Citric Acid
Hemorrhage
Vascular Access Devices
Neonatal Intensive Care Units
Fibrinolysis
Blood Transfusion
Observational Studies
Reference Values
Outcome Assessment (Health Care)
Prospective Studies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Thromboelastography in term neonates : An alternative approach to evaluating coagulopathy. / Sewell, Elizabeth K.; Forman, Katie Rae; Wong, Edward C C; Gallagher, Meanavy; Luban, Naomi L C; Massaro, An N.

In: Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol. 102, No. 1, 01.01.2017, p. F79-F84.

Research output: Contribution to journalArticle

Sewell, Elizabeth K. ; Forman, Katie Rae ; Wong, Edward C C ; Gallagher, Meanavy ; Luban, Naomi L C ; Massaro, An N. / Thromboelastography in term neonates : An alternative approach to evaluating coagulopathy. In: Archives of Disease in Childhood: Fetal and Neonatal Edition. 2017 ; Vol. 102, No. 1. pp. F79-F84.
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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.",
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AU - Sewell, Elizabeth K.

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AU - Massaro, An N.

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AB - 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.

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