Hemostasis in Neonates with Perinatal Hypoxia—Laboratory Approach: A Systematic Review

Marina Tsaousi; Zoi Iliodromiti; Nicoletta Iacovidou; Eleni Karapati; Alma Sulaj; Andreas G. Tsantes; Chrysa Petropoulou; Theodora Boutsikou; Argirios E. Tsantes; Rozeta Sokou

doi:10.1055/s-0042-1758148

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2023; 49(04): 391-401
DOI: 10.1055/s-0042-1758148

Review Article

Hemostasis in Neonates with Perinatal Hypoxia—Laboratory Approach: A Systematic Review

Marina Tsaousi^*

¹Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Zoi Iliodromiti^*

¹Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Nicoletta Iacovidou

¹Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Eleni Karapati

¹Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Alma Sulaj

¹Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Andreas G. Tsantes

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

,

Chrysa Petropoulou

¹Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Theodora Boutsikou

¹Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Argirios E. Tsantes

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

,

Rozeta Sokou

¹Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

³Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikaia, Piraeus, Greece

› Author Affiliations

Abstract

Birth asphyxia, with an estimated prevalence of 1 to 6 per 1,000 live births, may lead to multiorgan dysfunction due to impaired oxygen and/or blood supply to various organ systems, including the hemostatic system. Coagulopathy, a common complication of perinatal asphyxia, has been described since the 1960s. The aim of this study was to systematically review the literature for records on the use of hemostasis tests in the evaluation of coagulation disorders, in neonates who had suffered from perinatal hypoxia or asphyxia. We identified published studies by searching PubMed and Scopus, up until April 2022. The literature search retrieved 37 articles fulfilling the inclusion criteria of the review. According to the bibliography, thrombocytopenia is commonly associated with perinatal hypoxia/asphyxia. The thrombocytopenia is usually described as mild and platelets return to normal levels by the 10th day of life. Additionally, hypoxic neonates usually present with a hypocoagulable profile, as reflected by the prolongation of standard coagulation tests, including prothrombin time, activated partial thromboplastin time, and international normalized ratio, findings commonly associated with disseminated intravascular coagulation, and by the reduction of the levels of the physiologic inhibition of coagulation system. A few studies thus far using ROTEM/TEG in hypoxic neonates have come to the same conclusion as well; hypoxic newborns seem to be characterized by a hypocoagulable profile compared with healthy neonates. It should be emphasized, however, that standard coagulation tests provide only a rough estimation of the true bleeding or thrombotic risk of hypoxic neonates. On the contrary, viscoelastic methods seem to be more precise in the early detection of hemostasis disorders in the neonatal population. However, until now, there was uncertainty as to the most appropriate coagulation assays for diagnosis and management of coagulation derangement in neonates with perinatal hypoxia indicating the need for further research on this field.

Keywords

perinatal hypoxia - birth asphyxia - neonates - coagulopathy - standard coagulation tests - thromboelastometry/thromboelastography

Full Text

References

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