Reference ranges of thromboelastometry in healthy full-term and pre-term neonates

Area of Science:

• Neonatal hemostasis and coagulation
• Pediatric critical care diagnostics
• Point-of-care testing in neonatology

Background:

• Rotational thromboelastometry (ROTEM) offers rapid hemostasis assessment in neonates.
• Establishing reference ranges for ROTEM assays in neonates is crucial due to a lack of existing data.
• This study aimed to define reference ranges for the EXTEM assay in healthy full-term and pre-term neonates.

Purpose of the Study:

• To establish reference ranges for the extrinsically activated ROTEM assay (EXTEM) using arterial blood samples.
• To compare EXTEM parameters between healthy full-term and pre-term neonates.
• To identify potential differences in hemostasis parameters related to prematurity.

Main Methods:

• The EXTEM assay was performed on peripheral arterial whole blood samples.
• 198 full-term infants (≥37 weeks' gestation) and 84 pre-term infants (<37 weeks' gestation) were included.
• Key EXTEM parameters including clotting time, clot formation time, maximum clot firmness, and lysis index were analyzed.

Main Results:

• Reference ranges for EXTEM parameters were determined in full-term infants.
• A statistically significant difference was observed in the lysis index at 60 minutes (LI60) between full-term and pre-term neonates (p=0.006).
• LI60 showed an inverse correlation with gestational age and birth weight in pre-term neonates.

Conclusions:

• Pre-term neonates exhibit enhanced fibrinolytic activity.
• The established reference values for arterial newborn blood samples are largely comparable to those from cord blood studies.
• These provided reference values can inform future research and clinical practice in neonatal hemostasis.