Reference ranges of thromboelastometry in healthy full-term and pre-term neonates

AbstractBackground:Rotational thromboelastometry (ROTEM) is an attractive method for rapid evaluation of hemostasis in neonates. Currently, no reference values exist for ROTEM assays in full-term and pre-term neonates. Our aim was to establish reference ranges for standard extrinsically activated ROTEM assay (EXTEM) in arterial blood samples of healthy full-term and pre-term neonates.Methods:In the present study, EXTEM assay was performed in 198 full-term (≥37 weeks’ gestation) and 84 pre-term infants (<37 weeks’ gestation) using peripheral arterial whole blood samples.Results:Median values and reference ranges (2.5th and 97.5th percentiles) for the following main parameters of EXTEM assay were determined in full-term infants: clotting time (seconds), 41 (range, 25.9–78); clot formation time (seconds), 70 (range, 40–165.2); maximum clot firmness (mm), 66 (range, 41–84.1); lysis index at 60 min (LI60, %), 97 (range, 85–100). The only parameter with a statistically significant difference between full-term and pre-term neonates was LI60 (p=0.006). Furthermore, it was inversely correlated with gestational age (p=0.002) and birth weight (p=0.016) in pre-term neonates.Conclusions:In conclusion, an enhanced fibrinolytic activity in pre-term neonates was noted. For most EXTEM assay parameters, reference ranges obtained from arterial newborn blood samples were comparable with the respective values from studies using cord blood. Modified reagents, small size samples, timing of sampling, and different kind of samples might account for any discrepancies among similar studies. Reference values hereby provided can be used in future studies.

Download Full-text

Clot formation of neonates tested by thromboelastography correlates with gestational age

Thrombosis and Haemostasis ◽

10.1160/th09-05-0282 ◽

2010 ◽

Vol 103 (02) ◽

pp. 344-350 ◽

Cited By ~ 46

Author(s):

Tzipi Strauss ◽

Yael Levy-Shraga ◽

Bruria Ravid ◽

Irit Schushan-Eisen ◽

Ayala Maayan-Metzger ◽

...

Keyword(s):

Cord Blood ◽

Gestational Age ◽

Blood Clot ◽

Full Term ◽

Clot Formation ◽

Clotting Time ◽

Term Infants ◽

Term Neonates ◽

Pregnancy And Delivery ◽

Clot Formation Time

SummaryEvaluation 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. For each infant demographic information and data regarding pregnancy and delivery were gathered. Infants were prospectively followed until discharge. CT and CFT were significantly shorter among pre-term and term infants as compared to adults [median CT: 185, 194, 293 seconds respectively, p≤0.001, CFT: 80, 76, 103 seconds respectively, p≤0.001). MCF was lower in pre-term and term as compared to adults (p≤0.001) with significantly lower values in pre-term as compared to full-term neonates (p=0.004). Clotting time and MCF correlated with gestational age (R=0.132, p=0.045, R= 0.259, p<0.001, respectively). No association was found between any ROTEM values and the occurrence of post-natal complications in infants of our study group. This is the first study assessing clot formation by ROTEM in pre-term infants. Clot formation parameters of term and premature infants correlated with gestational age. The predictive value of clot formation tests in neonates deserves further attention.

Download Full-text

Reference Values of Thromboelastometry Parameters in Healthy Term Neonates Using NATEM in Cord Blood Samples

Children ◽

10.3390/children9010047 ◽

2022 ◽

Vol 9 (1) ◽

pp. 47

Author(s):

Alma Sulaj ◽

Marina Tsaousi ◽

Eleni Karapati ◽

Abraham Pouliakis ◽

Zoi Iliodromiti ◽

...

Keyword(s):

Cord Blood ◽

Reference Group ◽

Delivery Mode ◽

Coagulation Disorder ◽

Reference Ranges ◽

Term Neonates ◽

Blood Samples ◽

Α Angle ◽

Anticoagulant Medication ◽

Clot Formation Time

Background: ROTEM assay has gained increasing acceptance as a method for rapid and specific coagulation pathway assessment. However, its use in the neonatal population remains limited since reference ranges have not yet been established. Aims: (1) to determine reference ranges for healthy term neonates of ROTEM parameters using non-activated assay (NATEM) in cord blood samples; (2) to assess whether delivery mode, gender, gestational age, birth weight and blood group (ABO and Rhesus) of the neonate, coagulation disorder and anticoagulant medication of the mother have an impact on NATEM parameters. Methods: NATEM assay was conducted in cord blood samples of 189 term neonates without any medical history. Results: Reference ranges (2.5th and 97.5th percentiles) are established for clotting time (CT), clot formation time (CFT), α-angle, clot amplitude at 5, 10 and 20 min (A5, A10, A20), maximum clot firmness (MCF), lysis index at 30 and 60 min (LI30, LI60, %) and maximum clot elasticity (MCE). Reference ranges for NATEM are CT 182–499 s, CFT 63–176 s, α-angle 58–78°, A5 28–52 mm, A10 37–61 mm, A20 42–66 mm, MCF 43–67 mm, LI30 97–100%, LI60 87–98% and MCE 75–203. Male neonates appear to be more hypocoagulable than females. Conclusions: We demonstrate reference ranges for healthy term neonates in NATEM assay that could be used as a reference group for future studies of neonates with an underlying pathology.

Download Full-text

Reduction in Obstructive Breathing Events During Body Rocking: A Controlled Polygraphic Study in Preterm and Full-Term Infants

PEDIATRICS ◽

10.1542/peds.96.1.64 ◽

1995 ◽

Vol 96 (1) ◽

pp. 64-68

Author(s):

J. Groswasser ◽

M. Sottiaux ◽

E. Rebuffat ◽

T. Simon ◽

M. Vandeweyer ◽

...

Keyword(s):

Eye Movement ◽

Preterm Infants ◽

Upper Airway ◽

Periodic Breathing ◽

Full Term ◽

Rapid Eye Movement ◽

Term Infants ◽

Obstructive Sleep ◽

Significant Difference ◽

Obstructive Sleep Apneas

Objective. To investigate the effect of body rocking on infant respiratory behavior during sleep. Methods. Eighteen infants with documented obstructive sleep apneas were studied. There were eight premature infants with persistent bradycardias and 10 infants born full-term, admitted after an idiopathic apparent life-threatening event. No cause for the obstructive apneas was found. The infants were recorded with polygraphic techniques during two successive nights. They were randomly assigned to a rocking or a nonrocking mattress. The conditions were reversed the following night, in a crossover design. Results. In both groups of infants, no significant difference was seen between the two consecutive nights for most of the variables studied: total sleep time, the proportion of non-rapid-eye-movement and rapid-eye-movement sleep, the number of arousals, the number and maximal duration of central apneas, the frequency of periodic breathing, the level of oxygen saturation, and heart rate. During the nonrocking nights, all infants had repeated obstructive breathing events. In seven of the eight preterm infants and in nine of the 10 full-term subjects, body rocking was associated with a significant decrease in the frequency of obstructive events. During rocking, in the preterm infants the obstructions fell from a median of 2.5 to 1.8 episodes per hour (P = .034). In the full-term infants, rocking reduced the obstructive events from a median of 1.5 obstructions per hour to 0.7 (P = .005). No difference was seen for the duration of the obstructive episodes. Conclusion. In preterm and full-term infants prone to obstructive sleep apneas, gentle side-to-side body rocking is associated with a significant decrease in the frequency of upper-airway obstructions.

Download Full-text

Study of thyroid volume by ultrasonography in clinically euthyroid patients

Journal of Institute of Medicine ◽

10.3126/jiom.v32i2.4944 ◽

1970 ◽

Vol 32 (2) ◽

pp. 36-43 ◽

Cited By ~ 1

Author(s):

P Kayastha ◽

S Paudel ◽

DM Shrestha ◽

RJ Ghimire ◽

S Pradhan

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Reference Values ◽

Body Surface ◽

Pearson Correlation ◽

Thyroid Volume ◽

Specific Reference ◽

Reference Ranges ◽

Hilly Region ◽

Significant Difference

Introduction: The purpose of this study was to establish reference ranges of total thyroid volume among clinically euthyroid Nepalese population using Ultrasonography and correlate this volume with age, sex, individual’s built and geographic location. Methods: This was a prospective cross sectional study involving 485 clinically euthyroid individuals. B - mode Ultrasonography was used to measure the total thyroid volume by combining the volume of both the lobes obtained by using formula for prolate ellipsoid. Age specific reference values for thyroid volume were obtained and Pearson correlation test was used to see the relationship with various factors. Results: Among 485 individuals between 1 to 83 years of age, 221(45.57%) were males and 264(54.43%) were females. Maximum [354 individuals (72.99%)] were from hilly region and minimum [16 individual (3.30%)] were from Himalayan region. Mean thyroid volume was 6.629 ± 2.5025 ml. In general, thyroid volume was found to be more in older individuals than in young age group. There was no significant difference of thyroid volume between males and females. Thyroid volume best correlated with body surface area (r=0.444, p<0.0001). The volume had a positive correlation with weight (r=0.443, p<0.0001), body mass index (r=0.371, p<0.0001) and height (r=0.320, p<0.0001) of the individual. Conclusions: This study estimated the reference range of total thyroid volume for Nepalese population. These ranges are significantly lower than the WHO/ICCIDD thyroid volume references and reference values obtained in various other countries. Total thyroid volume best correlated with Body surface area. Keywords: Body surface area; clinically euthyroid; total thyroid volume; ultrasonography DOI: http://dx.doi.org/10.3126/joim.v32i2.4944 Journal of Institute of Medicine, August, 2010; 32: 36-43

Download Full-text

The Lowering of Bilirubin Levels in Full-Term Newborns by the Effect of Combined Massage Therapy and Phototherapy Practice

American Journal of Perinatology ◽

10.1055/s-0039-1685493 ◽

2019 ◽

Author(s):

Shokoufeh Ahmadipour ◽

Mahnaz Mardani ◽

Azam Mohsenzadeh ◽

Parastoo Baharvand ◽

Mohammad Nazeri

Keyword(s):

Bilirubin Level ◽

Intervention Group ◽

Massage Therapy ◽

Serum Bilirubin Level ◽

Full Term ◽

Control Group ◽

Term Infants ◽

Significant Difference ◽

Duration Of Hospitalization ◽

And Control

Objective Various therapeutic treatments have been prescribed for decreasing the bilirubin level. Massage therapy is one of the neonate treatments for jaundice. The aim of this study is to investigate the effects of combined massage therapy and phototherapy on neonatal jaundice. Study Design This study was performed at Shahid Madani Hospital in the city of Khorramabad in 2016, where 83 healthy full-term infants were enrolled. They were selected through convenience sampling and then were randomly assigned to the intervention and control groups. The control group (n = 43) received phototherapy, whereas infants in the intervention group (n = 40) received 4 days of massage and phototherapy. The serum bilirubin level, frequency of stooling and amount of urination, duration of hospitalization, and feeding frequency were analyzed using SPSS by descriptive and analytical statistics (mixed regression models). Results Baseline levels of bilirubin were similar between the two groups (p > 0.05). The bilirubin level was measured as 13.4 ± 0.7 mg/dL in the intervention group on day 1. It stood at 14.4 ± 1.5 mg/dL in the control group, which was not statistically significantly different. However, the mean bilirubin level was decreased on day 4 of hospitalization to 7.4 ± 0.56 mg/dL and 9.0 ± 2.3 mg/dL, showing a significant difference decrease in the intervention and control group (p < 0.05), respectively. Conclusion Intervention had a significant role in decreasing the bilirubin level, amount of urination, and duration of hospitalization of full-term infants suffering from hyperbilirubinemia.

Download Full-text

THE POSTNATAL DEVELOPMENT OF THE COAGULATION SYSTEM IN THE PREMATURE INFANT

10.1055/s-0038-1643606 ◽

1987 ◽

Cited By ~ 1

Author(s):

M Andrew ◽

B A Paes ◽

R A Milner ◽

P J Powers ◽

M Johnston ◽

...

Keyword(s):

Premature Infant ◽

Postnatal Development ◽

Premature Infants ◽

Reference Values ◽

Gestational Age ◽

Term Infant ◽

Full Term ◽

Screening Tests ◽

Coagulation System ◽

Term Infants

A cohort study was performed to determine the postnatal development of the coagulation system in the “healthy” premature infant. Mothers were approached for consent and a total of 132 premature infants were entered into the study. The group consisted of 64 infants with gestational ages of 34-36 weeks (prem 1) and 68 infants whose gestational age was 33 weeks or less (prem 2). Demographic information and a 2 ml blood sample were obtained on days 1, 5, 30, 90, and 180. Plasma was fractionated and stored at −70°C for batch assaying of the following tests: screening tests, PT, APTT; factor assays (biologic (B)); fibrinogen, II, V, VII, VIII:C, IX, X, XI, XII, prekallikrein, high molecular weight kininogen, XIII (immunologic (I)); inhibitors (I), antithrombin III, aα2-antiplasmin, α2-macroglobulin, α-anti-trypsin, Cl esterase inhibitor, protein C, protein S, and the fibrinolytic system (B); plasminogen. We have previously reported an identical study for 118 full term infants. The large number of premature and full term infants studied at varying time points allowed us to determine the following: 1) coagulation tests vary with the gestational age and postnatal age of the infant; 2) each factor has a unique postnatal pattern of maturation; 3) near adult values are achieved by 6 months of age; 4) premature infants have a more rapid postnatal development of the coagulation system compared to the full term infant; and 5) the range of reference values for two age groups of premature infants has been established for each of the assays. These reference values will provide a basis for future investigation of specific hemorrhagic and thrombotic problems in the newborn infant.

Download Full-text

Light deprivation increases plasma levels of melatonin during the first 72 h of life in human infants

Acta Endocrinologica ◽

10.1530/acta.0.1290442 ◽

1993 ◽

Vol 129 (5) ◽

pp. 442-445 ◽

Cited By ~ 22

Author(s):

F Jaldo-Alba ◽

A Muñóz-Hoyos ◽

A Molina-Carballo ◽

JA Molina-Font ◽

D Acuña-Castroviejo

Keyword(s):

Pineal Gland ◽

Continuous Light ◽

Full Term ◽

Light Deprivation ◽

Suprachiasmatic Nuclei ◽

Melatonin Secretion ◽

Human Infants ◽

Term Infants ◽

Term Neonates ◽

Plasma Bilirubin

The development of rhythmic melatonin secretion in full-term neonates seems to occur at about 12 weeks of age, but activity of the pineal gland from 1 to 12 weeks of age is not well documented. To determine whether the pineal gland actively secretes melatonin and reacts to photoperiodic information during this period, we analyzed 45 full-term infants exposed to continuous artificial light during 24, 48 and 72 h after birth for treatment of hyperbilirubinemia. During this light treatment, the eyes of the neonates were completely covered to avoid damage, thus the infants were under continuous light deprivation. Phototherapy significantly decreased plasma bilirubin during treatment. With regard to pineal gland activity, the shortest period of light deprivation tested, 24 h, significantly increased plasma melatonin levels from 152.66±11.57 to 244.86±19.49 ng/l (mean±sem; p<0.001). The other periods tested, 48 and 72 h of light deprivation, led to similar percentages of melatonin stimulation. These results suggest that the pineal gland of neonates, before displaying rhythmic metabolic activity, is sensitive to changes in environmental illumination, indicating maturity of some features of suprachiasmatic nuclei function.

Download Full-text

INVASIVENESS OF PHARMACOKINETIC STUDIES IN CHILDREN–A SYSTEMATIC REVIEW

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-310148.6 ◽

2015 ◽

Vol 101 (1) ◽

pp. e1.56-e1

Author(s):

Mohammed Altamimi ◽

Helen Sammons ◽

Imti Choonara

Keyword(s):

Sample Volume ◽

Blood Sampling ◽

Cochrane Library ◽

Preterm Neonates ◽

Pharmacokinetic Studies ◽

Individual Sample ◽

Term Neonates ◽

Blood Samples ◽

Significant Difference ◽

The Individual

ObjectivesTo compare the invasiveness of recent pharmacokinetic (PK) studies with older studies. The extent of this will be evaluated by analysing the number of samples and volume of blood collected in each study.MethodsA systematic literature review was performed to identify papers describing number of samples and volume of blood collected in studies of children (aged 0–18 years). The following databases were searched: Medline (1946 to May 2014), Embase (1974 to May 2014), International Pharmaceutical Abstracts (1970 to May 2014), CINAHL and Cochrane library. The keywords were “preterm neonate*” OR term neonate*” OR “neonate*” OR “new-born*” OR “child*” OR children OR “p*ediatric* OR “infant*” OR “adolescent*” AND “pharmacokinetic*” OR blood OR plasma OR specimen OR serum OR blood sampling OR blood sample*. Patients were grouped according to the guidelines of the International Conference of Harmonization (ICH), i.e. preterm neonates, term neonates, infants (28 days-under 2 years), children (2–11 years) and adolescents (12−≤18 years).ResultsA total of 501 paediatric PK studies were identified between 1974 and 2014. Eighty eight studies were conducted between 1980 and 1990 (old studies), while 193 were conducted between 2004 and 2014 (new studies). Significantly more blood samples per child were collected in the old (median 8 [IQR: 6–11]) versus the new studies (median 7 [IQR: 5–9]) (p=0.002). In children the frequency of blood sampling was significantly higher in old studies (median 9 [IQR: 7–12]) compared to new studies (p=0.0002), but in the other age categories, there were no significant differences. There was no significant difference in the individual sample volume collected at each time point between two periods (p=0.913). However the total volume of blood collected for the study was significantly more in the old period (median=14 ml IQR [4.5–27.5 ml]) than in the new studies (median=11 ml, IQR [6–18 ml]) (p=0.040).ConclusionsSignificantly more blood samples and larger total volumes of blood were taken in the old studies compared to new PK studies involving children. No major difference in the individual sample volume was seen.

Download Full-text

Arterial blood flow and autonomic function in full-term infants

Clinical Physiology and Functional Imaging ◽

10.1111/j.1475-097x.2006.00661.x ◽

2006 ◽

Vol 26 (2) ◽

pp. 127-131 ◽

Cited By ~ 6

Author(s):

Nili Gabai ◽

Ayala Cohen ◽

Ayed Mahagney ◽

David Bader ◽

Emanuel Tirosh

Keyword(s):

Blood Flow ◽

Autonomic Function ◽

Full Term ◽

Arterial Blood Flow ◽

Term Infants ◽

Arterial Blood

Download Full-text

Effect of early and delayed cord clamping on hemoglobin and hematocrit among full term neonates.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.08.5574 ◽

2021 ◽

Vol 28 (08) ◽

pp. 1114-1119

Author(s):

Saqib Aslam ◽

◽

Sadaf Minhas ◽

Muhammad Azhar Farooq ◽

Beenish Bashir Mughal ◽

...

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Full Term ◽

P Value ◽

Delayed Cord Clamping ◽

Term Neonates ◽

Cord Clamping ◽

Significant Difference ◽

Early Cord Clamping ◽

The Mean

Objective: To compare the mean hemoglobin levels and frequency of polycythemia in full term neonates after early and delayed cord clamping. Study Design: Randomized Controlled Trial. Setting: KRL General Hospital Islamabad (Labor Room/ Neonatology). Periods: December 2017 to June 2018. Material & Methods: 190 full term neonates were selected and divided into 2 equal groups randomly: Early cord clamping group after delivery and late cord clamping group. Two hours after clamping the venous blood samples were taken for the hemoglobin and hematocrit levels. Mean and standard deviation were calculated for gestational age, birth weight, hemoglobin and hematocrit. Frequency and proportions were calculated for gender and polycythemia. Results: Mean gestational age of the mothers was 39.27 ± 1.50 weeks. Of 190 neonates, 91 (47.9%) were males, 99 (52.1%) were females. Mean birth weight was 3.64 ± 0.72 kg while mean Hb and HCT levels were 16.07 ± 2.30 g/dl and 63.26 ± 5.32% respectively. Keeping cut off value of 13.5 g/dl of Hb to label anemia or no, 35 (18.4%) neonates were anemic in this study. The polycythemia (HCT >65%) was present in 72 (37.9%) of neonates. There was no difference between groups in terms of gender, anemia, gestational age and birth weight (p values 0.663, 0.852, 0.700 and 0.491 respectively). The distribution of polycythemia was different among groups (p value 0.007). The mean hemoglobin level in group A was 15.52 ± 1.90 g/dl while in group B it was 16.62 ± 2.53 g/dl (p value 0.001). Mean Hb levels were statistically not different among some of the groups (gestational age <40 weeks, birth weight <4 kg) while HCT levels are significantly different among male group and category of birth weight >4 kg. Rest of the stratification groups showed significant difference. Conclusion: The delayed cord clamping in neonates results in increased mean hemoglobin and hematocrit levels with increased frequency of polycythemia as compared to early cord clamping.

Download Full-text