Reference values for coagulation assessment in full-term newborns

Most data in the literature report reduced coagulation activities in the first few days of life with respect to adults and the effects of these differences must be considered when diagnosing and treating hemostatic disorders. The management of pediatric population is further complicated by the lack of age-related reference values and by the unreliability of currently-used hemostatic tests, while an accurate interpretation of results is required to reduce the cases of inappropriate investigation. Thromboelastography (TEG®) is a point-of-care test that provides an efficient analysis of the dynamic viscoelastic properties of whole blood that may provide superior evaluation and management of coagulopathies in newborn. This study was designed to determine reference values for kaolin-activated TEG in full-term healthy newborn by taking small blood samples from the umbilical cord and facilitate accurate interpretation of neonatal TEG results.

Kaolin-activated TEG was performed in 85 full-term healthy newborn and 40 healthy adults. TEG data analyzed were: reaction time, clot formation time, α-angle, maximum amplitude, clot lysis at 30 minutes, Functional Fibrinogen and coagulation index.

Reference values for kaolin-activated TEG in healthy full-term newborn are presented, despite a large variability in reaction time, clot formation time and in coagulation index, not significant impact on range values was evident and no significant differences between neonates and adults were observed.

Neonatal coagulation tests are closer to adult standards and although significant age-related differences in kaolin-activated TEG variables do not appear to be present, the usefulness of TEG for pediatric population is an open field that needs to be further evaluated, the results of this study can be used to interpret the data for newborn.