Thromboelastometry in Neonates with Respiratory Distress Syndrome: A Pilot Study.

Georgios N Katsaras,Anastasios G Kriebardis,Argirios E Tsantes,Daniele Piovani,Rozeta Sokou,Georgios Mitsiakos,Stefanos Bonovas,Dimitra Gialamprinou,Aikaterini Konstantinidi,Styliani Kokoris,Andreas G Tsantes

doi:10.3390/diagnostics11111995

Abstract

Background: Although respiratory distress syndrome (RDS) constitutes a postnatal risk factor for bleeding and thromboembolic events in neonates, few studies have addressed this issue. We aimed to evaluate the hemostatic profile of neonates with RDS using rotational thromboelastometry (ROTEM). Methods: An observational study was conducted from November 2018 to November 2020 in the NICU of General Hospital of Nikaia “Aghios Panteleimon”. Preterm and term neonates with RDS hospitalized in the NICU were included and EXTEM (tissue factor-triggered extrinsic pathway), INTEM (ellagic acid activated intrinsic pathway), and FIBTEM (with platelet inhibitor cytochalasin D) assays were performed at the onset of the disease. Results: A hypocoagulable profile was noted in neonates with RDS compared to controls, expressed as significant prolongation of EXTEM CT (clotting time) and CFT (clot formation time), lower EXTEM A10 (amplitude at 10 min), MCF (maximum clot firmness), and LI60 (lysis index). Furthermore, prolongation of INTEM CFT and FIBTEM CT, and decreased INTEM and FIBTEM A10 and MCF were found in neonates with RDS. Multivariable logistic regression analysis showed that RDS is an independent factor for the recorded alterations in ROTEM variables. Conclusions: RDS is associated with a hypocoagulable profile and greater hyperfibrinolytic potential compared to healthy neonates.

Highlights

In 1959, Avery and Mead discovered that the pathophysiology of hyaline membrane disease (HMD) involved pulmonary surfactant (PS) deficiency, and the disease name was changed to respiratory distress syndrome (RDS) [1]
Our sample consisted of 48 neonates (24 term and 24 preterm) (Median gestational age (GA): 36 weeks (IQR: 34.25–38 weeks)) that developed RDS during the study period, and were compared with 282 healthy neonates (198 term and 84 preterm) previously recruited regarding the extrinsically activated TEM (EXTEM) assay [33], and 102 newly recruited healthy neonates (85 term and 17 preterm) regarding the intrinsically activated TEM (INTEM) and fibrin based activated TEM (FIBTEM) assays
Our results showed a more hypocoagulable profile with higher fibrinolytic potential in both term and preterm neonates with RDS compared to healthy neonates

Summary

Introduction

In 1959, Avery and Mead discovered that the pathophysiology of hyaline membrane disease (HMD) involved pulmonary surfactant (PS) deficiency, and the disease name was changed to respiratory distress syndrome (RDS) [1]. The elevated thrombin/ antithrombin III (TAT) complexes and reduced antithrombin III (AT) activity seen in neonates with RDS have been correlated with the severity of the disease [7]. A more recent study showed that AT was not affected by RDS [13] This may be due to surfactant therapy, since its initiation in the 1980s, decreasing the incidence and severity of the disease and altering its pathway. Respiratory distress syndrome (RDS) constitutes a postnatal risk factor for bleeding and thromboembolic events in neonates, few studies have addressed this issue. Preterm and term neonates with RDS hospitalized in the NICU were included and EXTEM (tissue factor-triggered extrinsic pathway), INTEM (ellagic acid activated intrinsic pathway), and FIBTEM (with platelet inhibitor cytochalasin D) assays were performed at the onset of the disease. Conclusions: RDS is associated with a hypocoagulable profile and greater hyperfibrinolytic potential compared to healthy neonates

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Conclusion