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

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.

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Reference Values of Thrombolastometry Parameters in Healthy Term Neonates

Children ◽

10.3390/children7120259 ◽

2020 ◽

Vol 7 (12) ◽

pp. 259

Author(s):

Martha Theodoraki ◽

Rozeta Sokou ◽

Serena Valsami ◽

Zoi Iliodromiti ◽

Abraham Pouliakis ◽

...

Keyword(s):

Complete Blood Count ◽

Point Of Care ◽

Delivery Mode ◽

Reference Ranges ◽

Term Neonates ◽

Point Of Care Test ◽

Α Angle ◽

The Impact ◽

First Time ◽

Clot Formation Time

Background: Thromboelastometry (ROTEM), as a point of care test, is an attractive tool for rapid evaluation of hemostasis. Currently, no reference ranges exist for all ROTEM assays in neonates, limiting its use in this vulnerable population. The aim of the present study was: (1) to establish reference ranges for standard extrinsically activated (EXTEM), intrinsically activated (INTEM), and fibrinogen polymerization (FIBTEM) ROTEM assays in whole blood samples of healthy term neonates; (2) to determine the impact of gender, delivery mode, and hematocrit on ROTEM parameters. Methods: EXTEM, INTEM, and FIBTEM ROTEM assays were performed simultaneously with complete blood count in 215 healthy term neonates. Results: Reference ranges (2.5th and 97.5th percentiles) were obtained for clotting time (CT), clot formation time (CFT), α-angle, clot firmness at 10 min (A10), maximum clot firmness (MCF), and lysis index at 60 min (LI60, %). Reference ranges for EXTEM were CT 38–78 s, CFT 49–148 s, A10 40–65 mm, and MCF 47–69 mm, LI60 83–98%. For INTEM, CT 134–270 s, CFT 50–142 s, A10 41–63 mm, and MCF 48–67 mm, LI60 85–97%, and finally, for FIBTEM: CT 36–85 s, A10 9–25 mm and MCF 10–26 mm, LI60 92–100%. Hematocrit values were positively correlated with CT, CFT and negatively with A10, MCF values. Conclusion: This study provides, for the first time, reference ranges for ROTEM EXTEM/INTEM/FIBTEM values simultaneously in healthy term neonates. The combined evaluation of ROTEM tests increases its diagnostic accuracy, contributing to the expansion of ROTEM use in the neonatal population.

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

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2016-0931 ◽

2017 ◽

Vol 55 (10) ◽

Cited By ~ 17

Author(s):

Rozeta Sokou ◽

Leontini Foudoulaki-Paparizos ◽

Theodore Lytras ◽

Aikaterini Konstantinidi ◽

Martha Theodoraki ◽

...

Keyword(s):

Reference Values ◽

Full Term ◽

Reference Ranges ◽

Term Infants ◽

Term Neonates ◽

Blood Samples ◽

Arterial Blood ◽

Significant Difference ◽

Peripheral Arterial ◽

Clot Formation Time

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.

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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.

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Establishing reference ranges of cord blood: point-of-care hemostatic function assessment in preterm and term neonates

Pediatric Research ◽

10.1038/s41390-020-01310-8 ◽

2020 ◽

Author(s):

Marion Wiegele ◽

Oliver Kimberger ◽

Eva Schaden ◽

Peter Marhofer ◽

Andreas Baierl ◽

...

Keyword(s):

Cord Blood ◽

Point Of Care ◽

Reference Ranges ◽

Term Neonates ◽

Function Assessment

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Cord-blood derived chemistry reference values in preterm infants for sodium, chloride, potassium, glucose, and creatinine

American Journal of Perinatology ◽

10.1055/a-1730-8536 ◽

2022 ◽

Author(s):

Amelie Isabell Stritzke ◽

Rana Ismail ◽

Sarah Rose ◽

Andrew Lyon ◽

Tanis Fenton

Keyword(s):

Sodium Chloride ◽

Cord Blood ◽

Preterm Infants ◽

Reference Values ◽

Fluid Management ◽

Reference Intervals ◽

Delivery Mode ◽

Reference Ranges ◽

Normal Ranges ◽

Lower Glucose

Objectives: Guidelines recommend preterm infants be supported to maintain their serum electrolytes within “normal” ranges. In term babies, cord blood values differed in pathological pregnancies from healthy ones. Study design: We examined cord blood sodium, chloride, potassium, glucose, and creatinine to derive maturity-related reference intervals. We examined associations with gestational age, delivery mode, singleton versus multiple, and prenatal maternal adverse conditions. We compared preterm cord values to term, and to adult reference ranges. Results: There were 591 infants, 537 preterm and 54 term. Preterm cord glucose levels were steady (3.7+/-1.1mmol/l), while sodium, chloride and creatinine increased over GA by 0.17, 0.14 and 1.07 micromol/week respectively (p<0.003). Average preterm cord potassium and chloride were higher than term (p<0.05). Compared to adult reference intervals, cord preterm reference intervals were higher for chloride (100-111 vs 98-106 mmol/l), lower for creatinine (29-84 vs 62-115 micromol/l), more variable for potassium (2.7-7.9 vs. 3.5-5.0 mmol/l) and sodium (130-141 vs. 136-145 mmol/l). Cesarean section was associated with higher potassium and lower glucose; multiple births with higher chloride and creatinine and lower glucose; SGA with lower glucose. Conclusions: Cord blood values vary across the GA range with increases in sodium, chloride and creatinine while glucose remained steady. Average preterm reference values were higher than term values for potassium and chloride. Preterm reference values differed from published adults’ reference values. The varies across GA and by delivery mode, SGA, and being a multiple, which may have direct implications for neonatal care and fluid management.

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Cord Blood Alkaline Phosphatase as a predictor of Neonatal Jaundice in full term neonates

Zagazig University Medical Journal ◽

10.21608/zumj.2020.43247.1948 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Samah Esmail ◽

Ali Abdo ◽

Sherief Elgebaly ◽

Marwa Mostafa

Keyword(s):

Alkaline Phosphatase ◽

Cord Blood ◽

Neonatal Jaundice ◽

Full Term ◽

Term Neonates

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Computerized method for validating laboratory reference ranges for triiodothyronine and thyroxin immunoassays

Clinical Chemistry ◽

10.1093/clinchem/37.3.438 ◽

1991 ◽

Vol 37 (3) ◽

pp. 438-442 ◽

Cited By ~ 1

Author(s):

Brian Luttrell ◽

Sall Watters

Keyword(s):

Reference Range ◽

Normal Values ◽

Reference Group ◽

Normal Population ◽

Normal Subjects ◽

Reference Ranges ◽

Large Samples ◽

Laboratory Reference ◽

Euthyroid Status ◽

Computer Based

Abstract We used a computer-based method to help validate the reference ranges of assays for triiodothyronine (T3) and thyroxin (T4). A retrospective search of a database of laboratory results for the previous six months identified all patients with apparent euthyroid status, as defined by methods independent of the immunoassay under review. A computer-generated reference group (CGR Group) of 2001 records had a gaussian distribution of T4 values and a reference range (mean +/- 2 SD) of 56-161 nmol/L, compared with the supplier's suggested range for euthyroid subjects (58-148 nmol/L) and an in-house range of 60-144 nmol/L for a group of 97 normal subjects. A similar CGR Group of 1902 records gave a reference range for T3 of 0.7-2.1 nmol/L (manufacturer's range 0.8-2.8; normal subjects 0.8-2.2). An attempt to devise a reference range for thyrotropin failed when we found that its concentration in the population of patients with normal values for thyroid hormones was distributed differently from that in the normal population. The method is intended to be used in addition to conventionally derived ranges based on results for healthy subjects. It allows the laboratory to conveniently verify the reference ranges for T3 and T4 assays at regular intervals by using very large samples with appropriate age, sex, and weight distribution, drawn from the population of patients' samples submitted for analysis.

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Reference intervals for 26 common biochemical analytes in term neonates in Jilin Province, China

BMC Pediatrics ◽

10.1186/s12887-021-02565-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kaijin Wang ◽

Xuetong Zhu ◽

Qi Zhou ◽

Jiancheng Xu

Keyword(s):

Lactate Dehydrogenase ◽

Clinical Decision Making ◽

Reference Intervals ◽

Individual Characteristics ◽

Integrated System ◽

Delivery Mode ◽

Related Factor ◽

Term Neonates ◽

Age Related ◽

Laboratory Test Results

Abstract Background Biochemical analytes provide information for neonatal disease management and therapy, and population-based reference intervals (RIs) are essential to accurately interpret laboratory test results. This study aimed to establish local RIs for biochemical assays in term neonates. Methods A total of 195 healthy term neonates from birth to 3rd day were recruited as reference individuals prospectively. Analytes of 26 common biochemistries were measured using the VITROS 5600 Integrated System. The 3-level nested ANOVA was performed to assess the need for partitioning RIs of each analyte, and RIs were derived by a nonparametric method or robust method. Multiple regression analysis was used to evaluate specific correlations between the analytes and individual characteristics including age, gender, gestational age, birthweight and delivery mode. Results There were no between-sex differences in all analytes, whereas there were significant between-day-age differences in 6 analytes. Small between-delivery-mode differences were observed in the results for potassium, phosphorus, and urea. The major related factor of most analytes was postnatal age. During the first 3 days, values of iron, lipids and lipoproteins increased; creatinine, urea, uric acid, creatine kinase and lactate dehydrogenase decreased; other analytes showed slight changes or relatively stable trends. Reference limits of some analytes, particularly lactate dehydrogenase and alkaline phosphatase, were significantly different from adult and pediatric groups. Conclusions RIs of 26 common biochemical analytes are established for term neonates aged 0 to 3 days in northeast China. Additionally, it is suggested that age-related changes should be valued in the clinical decision-making process for newborns.

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Role of Cord Blood Carboxyhemoglobin in Detecting Significant Hyperbilirubinemia in Term Neonates with ABO Alloimmunization

American Journal of Perinatology ◽

10.1055/s-0040-1722328 ◽

2021 ◽

Author(s):

Mahir Tıraş ◽

Emrah Can ◽

Şahin Hamilçıkan

Keyword(s):

Cord Blood ◽

Total Serum ◽

Healthy Controls ◽

Term Neonates ◽

Group Iii ◽

Group I ◽

Significant Difference ◽

Group Ii ◽

Positive Direct ◽

Severe Hyperbilirubinemia

Objective This study aimed to assess whether cord blood carboxyhemoglobin (COHb) levels in jaundiced term neonates with and without a positive direct Coombs test (DCT) and in healthy controls could be used as a predictor of severe hyperbilirubinemia. The percentage of cord blood COHb should be higher among neonates with Coombs-positive ABO hemolytic disease than among those with Coombs-negative ABO incompatibility and higher than that of ABO-compatible control neonates. Study Design This cross-sectional descriptive study of 198 term neonates comprised three subgroups: group I featured 68 DCT-positive ABO-incompatible neonates (ABO + DCT), group II featured 60 DCT-negative ABO-incompatible neonates with hyperbilirubinemia (ABO–DCT), and group III featured 70 healthy controls. COHb was determined by an OSM3 hemoximeter. Results Group I differed from groups II and III for cord blood bilirubin, cord blood hemoglobin, and cord blood hematocrit. Groups I and II had higher mean total serum bilirubin (TSB) levels than group III, while there was no difference in the mean TSB levels between groups I and II. There was no significant difference between the COHb group means for groups I, II, and III (p = 0.98). The area under the receiver operating characteristic curve calculated for group I/group III and group II/group III were found to be 0.62 and 0.54, respectively. Conclusion COHb levels did not prove to be superior to the DCT for predicting the risk of developing severe hyperbilirubinemia in term neonates. Key Points

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