Labor Matters: Thromboelastometry Shows Differences in Newborn Hemostasis.

Area of Science:

• Neonatal physiology
• Hemostasis and thrombosis
• Coagulation diagnostics

Background:

• Neonatal coagulation differs from adult physiology.
• Conventional tests offer limited functional insight into newborn clot formation.
• Rotational thromboelastometry (ROTEM) provides dynamic, whole-blood analysis of clot dynamics.

Purpose of the Study:

• To investigate associations between mode of delivery and early postnatal ROTEM profiles in term neonates.
• To determine if delivery method impacts clot initiation, propagation, and firmness.
• To explore the influence of labor exposure on neonatal coagulation parameters.

Main Methods:

• Single-center cohort study of 60 healthy term neonates.
• Analysis of peripheral venous blood using ROTEM EXTEM and INTEM assays.
• Evaluated parameters: clotting time (CT), clot formation time (CFT), α-angle, clot amplitudes (A10-A30), maximum clot firmness (MCF), and maximum lysis (ML).
• Statistical analysis included non-parametric tests and multivariable regression.

Main Results:

• Elective cesarean neonates showed faster clot propagation and greater clot firmness (shorter INTEM CFT, higher INTEM α-angles, higher EXTEM/INTEM amplitudes).
• EXTEM MCF increased progressively from vaginal delivery to intrapartum cesarean to elective cesarean section.
• CT and ML did not differ significantly; mode of delivery remained independently associated with clot propagation and firmness parameters.

Conclusions:

• Mode of delivery, especially labor exposure, is associated with distinct early postnatal ROTEM profiles in term neonates.
• Perinatal context is crucial for interpreting viscoelastic coagulation testing in newborns.
• Findings support the development of delivery-specific reference intervals for neonatal coagulation assessment.