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Neonatal thromboelastography

Nischal K Gautam, Chunyan Cai, Olga Pawelek, Muhammad B Rafique, Davide Cattano, Evan G Pivalizza
BACKGROUND: Functional Fibrinogen assay of the Thromboelastography (FFTEG), a whole blood viscoelastic hemostatic assay, has been used to estimate fibrinogen levels in adult patients undergoing major surgery but its performance in pediatric patients undergoing cardiac surgery requires evaluation. In this study, we evaluate the correlation between FFTEG parameters and standard laboratory tests for fibrinogen and platelet counts before and after cardiopulmonary bypass in children undergoing repair for congenital heart disease...
February 2017: Paediatric Anaesthesia
Lucia Mirabella, Antonella Cotoia, Giusj Colacicco, Livio Tullo, Potito Salatto, Giuseppina Mollica, Karim Mariano, Michele Dambrosio, Gilda Cinnella
BACKGROUND: 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 haemostatic disorders. Management of pediatric population is further complicated by the lack of age-related reference values and by unreliability of hemostatic tests currently used while an accurate interpretation of results are required to reduce the cases of inappropriate investigation...
November 18, 2016: Minerva Anestesiologica
Elizabeth K Sewell, Katie R Forman, Edward C C Wong, Meanavy Gallagher, Naomi L C Luban, An N Massaro
OBJECTIVE: To develop normative ranges for citrate-modified and heparinase-modified thromboelastography (TEG) in term neonates. DESIGN: Prospective observational study. SETTING: An outborn neonatal and cardiac intensive care unit in a free-standing academic children's hospital. PATIENTS: Thirty term neonates were enrolled as control subjects. Seventeen infants with clinically documented bleeding requiring blood transfusion were enrolled in the comparison group...
January 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
Rakefet Sidlik, Tzipora Strauss, Iris Morag, Boris Shenkman, Ilia Tamarin, Aharon Lubetsky, Tami Livnat, Gili Kenet
BACKGROUND: The fibrinolytic system in newborns is immature and probably impaired. The aim of this study was to prospectively evaluate functional fibrinolytic capacity of newborn's cord blood using a new thromboelastometry (rotational thromboelastogram, ROTEM®) test. METHODS: Infants born at Sheba Medical Center were studied prospectively. Cord blood was obtained immediately after clumping, and ROTEM parameters were assessed applying non-activated TEM (NATEM) assay with increasing concentration of tissue plasminogen activator (tPA, 0-200 U/ml)...
May 2016: Pediatric Blood & Cancer
Maurizio Radicioni, Alessia Bruni, Vittorio Bini, Alfredo Villa, Carla Ferri
OBJECTIVE: To delineate thromboelastographic profiles of the premature infants with and without intracranial hemorrhage during the first 21 days of life. METHODS: In this study, 49 premature infants (24 female; 25 male) were consecutively admitted at our neonatal intensive care unit during a 6 months period were subject to thromboelastography and standard coagulation assessments at birth and weekly up to 21 days. Sixteen out of 49 infants developed intracranial hemorrhage at birth...
2015: Journal of Maternal-fetal & Neonatal Medicine
Katie R Forman, Edward Wong, Meanavy Gallagher, Robert McCarter, Naomi L C Luban, An N Massaro
BACKGROUND: Encephalopathic neonates undergoing therapeutic hypothermia have increased risk for coagulopathy secondary to perinatal asphyxia and effects of cooling on the coagulation enzyme cascade. Thromboelastography (TEG) allows for a comprehensive assessment of coagulation that can be regulated for temperature. TEG has not been previously evaluated in newborns undergoing hypothermia treatment. METHODS: Encephalopathic neonates treated with systemic hypothermia were enrolled in this prospective observational study...
May 2014: Pediatric Research
Bryan J Dicken, Aisha Bruce, Tarah M Samuel, Paul W Wales, Susan Nahirniak, Justine M Turner
Our clinical experience led us to reassess the effect of sole omega-3 lipid therapy on hemostasis. We compared thromboelastography platelet mapping in neonatal piglets given sole omega-3 lipid. We identified abnormalities in reaction time (P = .025) and the arachidonic acid pathway (P = .025). The potential for bleeding complications from parenteral omega-3 lipid emulsion therapy in high-risk infants with liver disease has been dismissed but, on the basis of this data, should be reconsidered.
March 2014: Journal of Pediatrics
Branden E Yee, Richard N Wissler, Christine N Zanghi, Changyong Feng, Michael P Eaton
BACKGROUND: Neonates are at high risk for bleeding complications after cardiovascular surgery. Activation of intravascular fibrinolysis is one of the principal effects of cardiopulmonary bypass that causes poor postoperative hemostasis. Antifibrinolytic medications such as tranexamic acid are often used as prophylaxis against fibrinolysis, but concentration/effect data to guide dosing are sparse for adults and have not been published for neonates. Higher concentrations of tranexamic acid than those necessary for inhibition of fibrinolysis may have adverse effects...
October 2013: Anesthesia and Analgesia
M Radicioni, D Mezzetti, A Del Vecchio, M Motta
AIM: To review the working principles of thromboelastography and evaluate the current knowledge about the possibility of its implementation in the neonatal intensive care unit setting. METHOD: Thorough search of the literature in the PubMed database (until May 31, 2012) concerning Thromboelastography (TEG) and/or Thromboelastometry (ROTEM) use in the newborn infant. RESULTS: Neonatal data are limited to a small number of healthy subjects and virtually absent in the extreme premature infant...
October 2012: Journal of Maternal-fetal & Neonatal Medicine
J L Mendez-Angulo, M Mudge, S Zaldivar-Lopez, P Vilar-Saavedra, G Couto
OBJECTIVES: To evaluate citrated recalcified thromboelastography (TEG) in healthy newborn foals, and to determine intra-assay, inter-individual and intra-individual (at 12 h, 24 h and 7 days after birth) variations. Additionally, to compare TEG variables, haematological values and conventional coagulation profiles from healthy, sick non-septic, and septic foals. DESIGN: Prospective study. METHODS: The study group comprised 18 healthy, 15 sick non-septic and 17 septic foals...
December 2011: Australian Veterinary Journal
F Ferrer-Marin, C Chavda, M Lampa, A D Michelson, A L Frelinger, M Sola-Visner
BACKGROUND: Thrombocytopenia is frequent among neonates, and 20-25% of affected infants are treated with platelet transfusions. These are frequently given for mild thrombocytopenia (platelets: 50-100 × 10(9) L(-1)), largely because of the known hyporeactivity of neonatal platelets. In tests of primary hemostasis, however, neonates have shorter bleeding and closure times (CTs) than adults. This has been attributed to their higher hematocrits, higher von Willebrand factor (VWF) concentrations, and predominance of longer VWF polymers...
May 2011: Journal of Thrombosis and Haemostasis: JTH
Nigel J Hall, Simon Eaton, Mark J Peters, Melanie P Hiorns, Nicholas Alexander, Denis V Azzopardi, Agostino Pierro
OBJECTIVES: Necrotizing enterocolitis (NEC) with multiple organ dysfunction syndrome (MODS) carries significant morbidity and mortality. There is extensive experimental evidence to support investigation of therapeutic hypothermia in infants with these conditions. We aimed to establish the feasibility and safety of mild hypothermia in preterm neonates with NEC and MODS as a prelude to a randomized trial. METHODS: This was a prospective, nonrandomized pilot study of 15 preterm infants who were referred for surgical intervention of advanced NEC and failure of at least 3 organs...
February 2010: Pediatrics
T Strauss, Y Levy-Shraga, B Ravid, I Schushan-Eisen, A Maayan-Metzger, J Kuint, G Kenet
Evaluation of clot formation in neonates is troublesome. Our aim was to investigate cord blood clot formation of pre-term versus full-term infants and adults, using rotating thromboelastogram (ROTEM), Pentafarm, Munich, Germany). ROTEM was investigated in cord blood of 184 full-term and 47 pre-term infants. Measurements of the clotting time (CT), clot formation time (CFT) and maximal clot firmness (MCF) were obtained in order to asses reference values for this age group, and compare between full-term and pre-term neonates and compared to adult controls...
February 2010: Thrombosis and Haemostasis
Sara J Israels
Investigation of platelet function disorders in infants and small children requires the collaborative efforts of clinicians and clinical laboratories. A detailed personal, family, and medication history, and a search for additional clinical phenomena may help to direct diagnostic laboratory investigations. Testing for these disorders in young children presents several challenges: the requirement of relatively large volumes of blood, lack of standardization, and the absence of well-established age-specific reference ranges...
March 2009: Seminars in Thrombosis and Hemostasis
Rachel M Edwards, Bindi Jayendra Naik-Mathuria, Andre Nicholas Gay, Oluyinka O Olutoye, Jun Teruya
Thromboelastography (TEG) aids in monitoring a patient's global hemostatic system by measuring the rate of clot formation, clot strength, and stability. The usefulness of TEG in pediatric settings, especially with neonates, is limited owing to a lack of neonatal reference values. In this study, neonatal TEG reference intervals were developed and results correlated with other coagulation test parameters. Samples were from women who delivered a neonate after at least 34 weeks of gestation in normal pregnancies...
July 2008: American Journal of Clinical Pathology
Martin Koestenberger, Siegfried Gallistl, Wolfgang Muntean, Ulrika Ferstl, Joerg Kutschera, Gerhard Cvirn
Recombinant activated factor VII (rFVIIa) has been reported to be effective in adult patients in various clinical situations and might be beneficial in neonates with bleeding tendency. In the present study we compared the procoagulant action of increasing amounts of rFVIIa in both cord whole blood and adult whole blood with respect to changes in the values of the clotting time, clot formation time, and maximum clot firmness by means of thromboelastography. Thromboelastography allows evaluation of the effects of rFVIIa on haemostasis in whole blood...
November 2005: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Stephan C Kettner, Arnold Pollak, Michael Zimpfer, Tanja Seybold, Andrea R Prusa, Kurt Herkner, Stefan Kuhle
UNLABELLED: Thrombelastography (TEG) appears to be a promising test to assess coagulation in infants and children. TEG enables a rapid assessment of hemostatic function with only 300 microL of whole blood and provides information about plasmatic coagulation, platelet function, and fibrinolysis. In this study, we used TEG to assess the coagulation system of preterm and term neonates to determine the effects of their deficient coagulation factor levels on global hemostatic function. Heparinase-modified TEG, platelet and red blood cell count, plasma fibrinogen, and prothrombin time were assessed in four groups of clinically stable infants: severely preterm (gestational age [GA], 27-31 wk), moderately preterm (GA, 32-36 wk), term (GA, 36-40 wk), and former preterm (corrected GA, 34-40 wk)...
June 2004: Anesthesia and Analgesia
G D Williams, S L Bratton, E C Riley, C Ramamoorthy
OBJECTIVES: To examine whether coagulation tests, sampled before and during cardiopulmonary bypass (CPB), are related to blood loss and blood product transfusion requirements, and to determine what test value(s) provide the best sensitivity and specificity for prediction of excessive hemorrhage. DESIGN: Prospective. SETTING: University-affiliated, pediatric medical center. PARTICIPANTS: Four hundred ninety-four children...
August 1999: Journal of Cardiothoracic and Vascular Anesthesia
H W Grant, G P Hadley
The thromboelastogram (TEG) measures functional defects in coagulation, from fibrin formation through platelet aggregation to fibrinolysis. It is comparable with standard laboratory tests of coagulation; however, it provides additional useful qualitative information. This prospective study documents the TEG findings in 103 neonates: 60 were normal and healthy and provided a reference range; 12 surgical babies had established sepsis, 15 had early sepsis, and 16 were non-septic. TEG abnormalities were detected only in those patients with early and established sepsis...
April 1997: Pediatric Surgery International
P Moalic, Y Gruel, P Foloppe, B Delahousse, M H Leclerc, J Leroy
Fetal and neonatal lamb hemostasis were studied from the 60th day of pregnancy to birth. Platelet counts and blood coagulation, as assessed by tests such as recalcification time and thromboelastography, were similar in fetuses, neonates, and adult sheep. The values of coagulation factors were low, ie, vitamin K-dependent Factors II, VII, IX, and X remained unchanged (30 and 40% of adult reference values) until the last 10 days of gestation, and then increased until birth (40 to 60%). Values of fibrinogen and Factor V followed a similar pattern, although their activities became identical to adult values at birth...
January 1989: American Journal of Veterinary Research
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