The Utility of NATEM Assay in Predicting Bleeding Risk in Critically Ill Neonates

Rozeta Sokou; Petroula Georgiadou; Andreas G. Tsantes; Stavroula Parastatidou; Aikaterini Konstantinidi; Georgios Ioakeimidis; Athanasia Makrogianni; Martha Theodoraki; Styliani Kokoris; Nicoletta Iacovidou; Anastasios G. Kriebardis; Daniele Piovani; Stefanos Bonovas; Argirios E. Tsantes

doi:10.1055/s-0042-1753513

Seminars in Thrombosis and Hemostasis, Inhaltsverzeichnis

Semin Thromb Hemost 2023; 49(02): 182-191
DOI: 10.1055/s-0042-1753513

Review Article

The Utility of NATEM Assay in Predicting Bleeding Risk in Critically Ill Neonates

Authors

Rozeta Sokou^*

¹Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece
Petroula Georgiadou^*

¹Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece
Andreas G. Tsantes^*

²Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Stavroula Parastatidou

¹Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece
Aikaterini Konstantinidi

¹Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece
Georgios Ioakeimidis

¹Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece
Athanasia Makrogianni

¹Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece
Martha Theodoraki

¹Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece
Styliani Kokoris

²Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Nicoletta Iacovidou

³Neonatal Department, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
Anastasios G. Kriebardis

⁴Laboratory of Reliability and Quality Control in Laboratory Hematology, Department of Biomedical Science, School of Health and Caring Science, University of West Attica, Egaleo, Athens, Greece
Daniele Piovani

⁵Department of Biomedical Sciences, Humanitas University, Milan, Italy

⁶IRCCS Humanitas Research Hospital, Milan, Italy
Stefanos Bonovas

⁵Department of Biomedical Sciences, Humanitas University, Milan, Italy

⁶IRCCS Humanitas Research Hospital, Milan, Italy
Argirios E. Tsantes

²Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

Abstract

We aimed to investigate the hemostatic status of diseased neonates using nonactivated rotational thromboelastometry (ROTEM) assay (NATEM) assay and, in addition, to evaluate the discriminative power of NATEM parameters in predicting the risk of bleeding in critically ill neonates and compare it to that of EXTEM (extrinsically activated ROTEM) parameters. This cohort study included 158 consecutive, critically ill neonates with presumed sepsis, perinatal hypoxia, or respiratory distress syndrome. The EXTEM and NATEM assays were performed on the first day of disease onset. The neonatal bleeding assessment tool was used to record and assess clinical bleeding events on the day of ROTEM analysis. Several EXTEM and NATEM ROTEM parameters differed between neonates with and without clinical bleeding events, indicating a hypo-coagulable state in neonates with clinical bleeding. NATEM parameters had comparable predictive performance for clinical bleeding events with EXTEM parameters for clotting time, clot formation time (CFT), A10 (clot amplitude at 10minutes), maximum clot firmness, lysis index at 60minutes, and maximum clot elasticity (p>0.05). However, NATEM A20, A30, and α angle demonstrated better predictive ability than EXTEM A20, A30, and α angle, respectively (p<0.05). A NATEM CFT value ≥147seconds presented 95.2% sensitivity (95% confidence interval [CI]: 76.1–99.8%) and 65.6% specificity (95% CI: 57.1–73.5%) to detect neonates with clinical bleeding, while a NATEM A10 value ≤42mm had 80.8% sensitivity (95% CI: 71.8–85.9%) and 76.0% specificity (95% CI: 52.8–91.7%) to detect neonates with clinical bleeding events. The NATEM assay has shown remarkable sensitivity in predicting bleeding in critically ill neonates, exceeding EXTEM performance in some selected parameters. The incorporation of NATEM test parameters in predictive models for neonatal hemorrhage seems promising.

Keywords

hemostatic status - neonatal hemostasis - critically ill neonates - thromboelastometry - nonactivated rotational ROTEM assay

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Referenzen

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