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Semin Thromb Hemost 2019; 45(05): 449-457
DOI: 10.1055/s-0039-1692210
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical Application of Thromboelastography/Thromboelastometry (TEG/TEM) in the Neonatal Population: A Narrative Review

Aikaterini Konstantinidi   *
1   NICU Nikaia General Hospital “Agios Panteleimon”, Piraeus, Greece
,
Rozeta Sokou   *
1   NICU Nikaia General Hospital “Agios Panteleimon”, Piraeus, Greece
,
Stavroula Parastatidou
1   NICU Nikaia General Hospital “Agios Panteleimon”, Piraeus, Greece
,
Katerina Lampropoulou
1   NICU Nikaia General Hospital “Agios Panteleimon”, Piraeus, Greece
,
George Katsaras
1   NICU Nikaia General Hospital “Agios Panteleimon”, Piraeus, Greece
,
Theodora Boutsikou
2   Neonatal Department, National and Kapodistrian University of Athens, Aretaeio Hospital, Athens, Greece
,
Antonios K. Gounaris
3   NICU, University Hospital of Larissa, Larissa, Greece
,
Argyrios E. Tsantes
4   Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
Nicoletta Iacovidou
2   Neonatal Department, National and Kapodistrian University of Athens, Aretaeio Hospital, Athens, Greece
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Publikationsdatum:
13. Juni 2019 (online)

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Abstract

Hemostasis is a dynamic age-related process, which gradually evolves from fetal life throughout childhood until adulthood. Although at birth there is a hemostatic deficit of most coagulation factors, studies have shown that this “hemostatic immaturity” is functionally counterbalanced in healthy term or preterm newborns. This delicate hemostatic balance is, however, deranged in sick neonates, resulting in an enhanced risk of hemorrhage and/or thrombosis. In critically ill neonates, conventional coagulation tests do not seem to provide reliable information or indications regarding the functional status of platelets or fibrinolysis. In contrast, viscoelastic tests, namely thromboelastography/thromboelastometry (TEG/TEM) hold promise for rapid assessment of the whole hemostatic potential, allowing immediate intervention should this be required. However, neonatal data are limited due to lack of reference values, especially in premature neonates. In this narrative review, we provide some insights around current knowledge regarding TEG/TEM applications in healthy and sick newborns. Overall, the use of viscoelastic tests in diagnosis and management of coagulation disorders in neonates is definitely worth further exploration. Consideration should be made to include these tests in the routine laboratory investigation of neonates and specific transfusion algorithms should also be developed in order to avoid treatment pitfalls.

Keywords

hemostasis - thromboelastography/thromboelastometry - conventional coagulation tests - neonates

Informed Consent

For this type of study formal consent is not required.


Authors' Contributions

A.K. and R.S. contributed to the conception and design of the study. All authors contributed to the interpretation of data for the work, drafted the manuscript and critically revised the article for important intellectual content, and approved the final version to be published.


* These authors share equal contribution.