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
