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

Sulaj, Alma; Tsaousi, Marina; Karapati, Eleni; Pouliakis, Abraham; Iliodromiti, Zoe; Boutsikou, Τheodora; Valsami, Serena; Iacovidou, Nicoletta; Politou, Marianna; Sokou, Rozeta

doi:10.3390/children9010047

Cited by 8 publications

(11 citation statements)

References 34 publications

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“…However, only two published studies investigated NATEM parameters in the neonatal population. Sidlik et al 38 examined the functional fibrinolytic capacity of newborn's cord blood, while Sulaj et al 39 proposed reference ranges for NATEM variables using cord blood samples in healthy full-term neonates. Our study was the first to evaluate NATEM parameters in critically ill neonates.…”

Section: Discussionmentioning

confidence: 99%

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

Sokou

Georgiadou

Tsantes

et al. 2022

Semin Thromb Hemost

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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.

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Section: Discussionmentioning

confidence: 99%

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

Sokou

Georgiadou

Tsantes

et al. 2022

Semin Thromb Hemost

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“…A total of 30 NATEM articles (1477 participants) from 2010 to 2022 were included. Twenty studies were conducted in Europe [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32], three studies were conducted in Japan [33][34][35] and the USA [36][37][38], one study in Australia [39], one in Russia [40], one in Brazil [41] and one study was conducted in Israel [42]. The outcomes from the 30 included studies were grouped into four categories: experimental study using NATEM assay (n = 7), evaluation of NATEM assay in healthy human volunteers (n = 8), in patients versus healthy volunteers (n = 7) and in patients only (n = 8).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The outcomes from the 30 included studies were grouped into four categories: experimental study using NATEM assay (n = 7), evaluation of NATEM assay in healthy human volunteers (n = 8), in patients versus healthy volunteers (n = 7) and in patients only (n = 8). All studies involved adults except from two studies that evaluated the NATEM assay in the neonatal population [32,42]. The median age of patients that was included in the studies ranged from neonatal age-three days of life-to 66 ± 15 years.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Seventeen studies evaluated the NATEM assay in various patient groups with different diseases, such as hemophilia A, cirrhosis with or without portal vein thrombosis, factor XI or VII deficiency, multiple myeloma, acute respiratory distress syndrome (ARDS), unclassified bleeding disorders, brain tumors, and disorders during pregnancy [14,17,[19][20][21][22]26,27,[33][34][35]37,40]. Only two studies enrolled neonates and the assessment of hemostatic profile and fibrinolysis in cord blood using NATEM [32,42].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…This was the first study regarding the functional fibrinolysis in cord blood, and the findings indicated that neonatal fibrinolysis is increased compared to adults. Sulaj et al [32] reported reference ranges for NATEM parameters in healthy-term neonates using cord blood samples and showed that the gestational age had a positive correlation with lysis index at 30 and 60 min; these results are in accordance with other studies performed in healthy neonates using intrinsically activated test with ellagic acid (INTEM) and extrinsically activated test with tissue factor (EXTEM) assays [43,44]. Moreover, female neonates appear to have a more hypercoagulable profile compared to males, manifested with faster CT and higher clot amplitude at 20 min (A20) and MCF; a finding which can attributed to the increased levels of coagulation factors that females present [45].…”

Section: Natem Assay Application In Healthy Human Volunteersmentioning

confidence: 99%

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The Non-Activated Thromboelastometry (NATEM) Assay’s Application among Adults and Neonatal/Pediatric Population: A Systematic Review

et al. 2022

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The non-activated thromboelastometry (NATEM) assay is a point-of-care assay that can provide a comprehensive insight into the actual hemostatic mechanism. However, there are very limited data about its use in clinical practice. The aim of this study was to systematically review the literature for any data regarding the use of NATEM in several clinical settings. A systematic review of PubMed and Scopus databases was conducted through 20 January 2022 for studies evaluating the use of the NATEM assay in different clinical settings. The literature search yielded a total of 47 publications, 30 of which met the eligibility criteria for this review. Evaluation of NATEM’s detecting ability for hemostasis disorders is limited in the literature. The results of the included studies indicate that NATEM seems to be a sensitive method for the detection of hyperfibrinolysis and may have an advantage in the diagnosis of hemostatic disorders. It could be more informative than the other ROTEM assays for detecting changes in coagulation parameters in patients who receive anticoagulants. However, the reported outcomes are highly varying among the included studies. NATEM has a high sensitivity to detect hypo- or hypercoagulability and provides a detailed insight into the whole hemostatic process from clot formation to clot breakdown. It could be a useful technique in variable fields of medicine, not only in adults, but also in pediatric and neonatal populations, to guide different hemostatic treatments and predict coagulation disorders or mortality/morbidity; this issue remains to be further investigated.

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Measuring and monitoring of hemostasis

Winkler

2024

Hemostasis Management of the Pediatric Surgical Patient

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

Cited by 8 publications

References 34 publications

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

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

The Non-Activated Thromboelastometry (NATEM) Assay’s Application among Adults and Neonatal/Pediatric Population: A Systematic Review

Measuring and monitoring of hemostasis

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