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Original research
Thromboelastographic profiles of healthy very low birthweight infants serially during their first month
  1. Genny Raffaeli1,2,
  2. Armando Tripodi3,
  3. Giacomo Cavallaro1,
  4. Valeria Cortesi1,2,
  5. Erica Scalambrino3,
  6. Nicola Pesenti4,
  7. Andrea Artoni3,
  8. Fabio Mosca1,2,
  9. Stefano Ghirardello1
  1. 1 NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  2. 2 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
  3. 3 Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  4. 4 Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano–Bicocca, Milan, Italy
  1. Correspondence to Dr Stefano Ghirardello, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan 20112, Italy; stefano.ghirardello{at}mangiagalli.it

Abstract

Objective We determined thromboelastographic (TEG) profiles of healthy very low birthweight infants (VLBWIs) of the day of birth and at set intervals during their first month.

Design Prospective observational study with blinded clinical and laboratory follow-up.

Setting Level III neonatal intensive care unit (June 2015 to June 2018).

Patients Consecutive qualifying VLBWIs were enrolled at birth and followed up for 30 days.

Interventions and main outcomes measures Laboratory (citrated-native TEG, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, blood count) and clinical variables were retrieved at birth, 3rd–5th, 10th and 30th day of life. Blood samples temporally related to events with a potential hemostatic impact (sepsis, bleeding, platelets/plasma transfusions, ibuprofen/indomethacin administration) were excluded from analysis.

Results We enrolled 201 VLBWIs and 72 full-term neonates. Sixty-seven of the healthy VLBWIs completed the 30-day follow-up. 541 TEG traces were analysed.

On day 1, the median (minimum–maximum) TEG values were as follows: reaction time (R), 8.2 min (1–21.8); kinetics (K), 2.8 min (0.8–16); α angle, 51° (14.2–80.6); maximum amplitude (MA), 54.9 mm (23.9–76.8). PT and APTT were 15.9 s (11.7–51.2) and 59 s (37.8–97.5), respectively. The above parameters suggest minor hypocoagulability compared with term infants. On day 30, the median (minimum–maximum) R was 5 (1–16.9), K 1 (0.8–4.1), α 74.7 (41.1–86.7) and MA 70.2 (35.8–79.7). PT and APTT were 12.1 (10.4–16.6) and 38.8 (29.6–51.4), respectively. Those parameters are consistent with a relatively hypercoagulable phenotype, compared with term infants.

Conclusions Healthy VLBWIs have a prolonged PT and APTT, but their TEG profiles suggest a relatively balanced hemostatic system, with slight hypocoagulability initially (compared with term neonates), gradually evolving to a somewhat more procoagulant phenotype over the first month.

  • thromboelastography
  • hemostasis
  • thrombosis
  • bleeding
  • neonate

https://doi.org/10.1136/archdischild-2019-317860

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    Footnotes

    • Presented at Preliminary results of this work were partially presented at the Pediatric Academic Society PAS Meeting 2018 and 2019 as platform presentation and at the XXV National Congress of the Italian Society for Thrombosis and Haemostasis—SISET 2018, as oral communication.

    • Contributors GR participated in the design of the work; she managed the enrolment of patients and acquisition of data; she gave substantial contributions to the analysis or interpretation of data. She wrote the first draft of the paper, gave final approval of the version published and ensured that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AT participated in the conceptualisation and design of the work; he gave essential contribution to the interpretation of data; he revised the work with important intellectual content and gave final approval of the version published. GC participated in the conceptualisation and design of the work; he gave substantial contribution to the interpretation of data; he critically revised the work and gave final approval of the version published. VC gave substantial contribution to the acquisition and analysis of data, she revised the work and gave final approval of the version published. ES participated to the acquisition, analysis and interpretation of data; she revised the work and gave final approval of the version published. NP managed the data analysis; he revised the work and gave final approval of the version published. AA gave substantial contribution to the interpretation of data; he critically revised the work and gave final approval of the version published. FM participated in the conceptualisation and design of the work; he gave substantial contribution to the interpretation of data; he critically revised the work and gave final approval of the version published. SG participated in the conceptualisation and design of the work; he supervised the enrolment, obtained the ethical local permissions and gave essential contribution to the interpretation of data. He revised the draft giving important intellectual contribution and gave final approval of the version published and ensured that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Parental/guardian consent obtained.

    • Ethics approval The Institutional Review Board approved the study protocol.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. All data relevant to the study are included in the article or uploaded as online supplementary information.