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Published on: June 29, 2013
Assessment of Hemostatic Profile in Neonates with Intrauterine Growth Restriction: A Systematic Review of Literature
Eleni Karapati1, Rozeta Sokou1,2, Zoi Iliodromiti1
1Neonatal Department, School of Medicine, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece.
Insights
Intrauterine growth restriction (IUGR) in neonates often causes mild thrombocytopenia and prolonged coagulation tests. However, current research lacks correlation with clinical bleeding or thrombosis, necessitating further investigation into neonatal hemostasis.
Area of Science:
- Neonatal Medicine
- Hematology
- Perinatal Research
Background:
- Intrauterine growth restriction (IUGR) affects 10-15% of pregnancies, leading to adverse outcomes including hemostatic derangements in neonates.
- Neonates with IUGR exhibit both thrombotic and hemorrhagic complications, highlighting the need for better understanding of their coagulation system.
- Evaluating the hemostatic system in small for gestational age neonates is critical for managing perinatal complications.
Approach:
- A systematic literature review was conducted using PubMed and Scopus databases up to September 2022.
- Sixty studies meeting inclusion/exclusion criteria were analyzed to assess laboratory evaluations of hemostasis in IUGR neonates.
- The review focused on platelet counts, standard coagulation tests, and advanced methods like thromboelastography/rotational thromboelastometry (TEG/ROTEM).
Key Points:
- Thrombocytopenia, often mild and resolving spontaneously, is a common finding in IUGR neonates due to chronic hypoxia.
- Standard coagulation tests in growth-restricted newborns frequently show prolonged results, but data on specific factors are scarce and conflicting.
- Limited data exists on TEG/ROTEM in this population, with one study showing no difference compared to appropriate for gestational age neonates.
Conclusions:
- Current laboratory findings in IUGR neonates, including thrombocytopenia and altered coagulation tests, do not consistently correlate with clinical bleeding or thrombosis.
- There is a significant need for more comprehensive studies to elucidate hemostatic abnormalities in IUGR neonates.
- Further research is essential to guide targeted therapeutic interventions for hemostatic derangements in this vulnerable population.
Abstract:
Intrauterine growth restriction (IUGR) affects nearly 10 to 15% of pregnancies and is responsible for many short- and long-term adverse consequences, including hemostatic derangement. Both thrombotic and hemorrhagic events are described in the perinatal period in these neonates. The aim of this study was to systematically review the literature on the laboratory studies used to evaluate the hemostatic system of the IUGR small for gestational age neonate. We reviewed the current literature via PubMed and Scopus until September 2022. Following our inclusion/exclusion criteria, we finally included 60 studies in our review. Thrombocytopenia, characterized as hyporegenerative and a kinetic upshot of reduced platelet production due to in utero chronic hypoxia, was the main finding of most studies focusing on growth-restricted neonates, in most cases is mild and usually resolves spontaneously with the first 2 weeks of life. In regard to coagulation, growth-restricted newborns present with prolonged standard coagulation tests. Data regarding coagulation factors, fibrinolytic system, and anticoagulant proteins are scarce and conflicting, mainly due to confounding factors. As thromboelastography/rotational thromboelastometry (TEG/ROTEM) provides a more precise evaluation of the in vivo coagulation process compared with standard coagulation tests, its use in transfusion guidance is fundamental. Only one study regarding TEG/ROTEM was retrieved from this population, where no difference in ROTEM parameters compared with appropriate for gestational age neonates was found. Despite the laboratory aberrations, no correlation could be achieved with clinical manifestations of bleeding or thrombosis in the studies included. More studies are needed to assess hemostasis in IUGR neonates and guide targeted therapeutic interventions.
