Viscoelastic coagulation testing in Neonatal Intensive Care Units: advantages and pitfalls in clinical practice

Area of Science:

• Pediatrics
• Hematology
• Physiology

Background:

• Neonatal hemostasis is a complex, age-related physiological process.
• Conventional coagulation tests are limited in assessing neonatal hemostatic function.
• Developmental hemostasis refers to maturational changes in the hemostatic system.

Purpose of the Study:

• To highlight the limitations of conventional coagulation tests in neonates.
• To emphasize the utility of viscoelastic coagulation tests (VCTs) in neonatal care.
• To discuss the role of VCTs in monitoring and managing hemostatic derangements.

Main Methods:

• Review of current literature on neonatal hemostasis.
• Comparison of conventional coagulation tests with VCTs (VCM, TEG, ROTEM).
• Discussion of VCT applications in neonatal intensive care units.

Main Results:

• Neonatal hemostatic system is competent but differs quantitatively and qualitatively from adults.
• VCTs provide a dynamic, global assessment of hemostasis, unlike static conventional tests.
• VCTs are increasingly used for monitoring, especially during extracorporeal membrane oxygenation.

Conclusions:

• Viscoelastic coagulation tests are valuable tools for assessing and managing neonatal hemostasis.
• Implementing VCTs can lead to prompt, individualized therapeutic interventions.
• VCTs can optimize blood product utilization and improve patient outcomes.