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PEDIATRIC ANESTHESIA

Heparinase-Modified Thrombelastography in Term and Preterm Neonates

Stephan C. Kettner, MD^*,, Arnold Pollak, MD, Michael Zimpfer, MD^*,, Tanja Seybold, MD^*, Andrea R. Prusa, MD, Kurt Herkner, MD, and Stefan Kuhle, MD

*Department of Anesthesiology and General Intensive Care, University of Vienna; Ludwig Boltzmann Institute of Clinical Anesthesiology and Intensive Care; Department of Neonatology and Intensive Care, University of Vienna; and Ludwig Boltzmann Institute of Pediatric Endocrinology and Immunology, University of Vienna, Vienna, Austria

Address correspondence and reprint requests to Stephan C. Kettner, MD, Department of Anesthesiology and General Intensive Care, General Hospital Vienna, 18-20 Währinger Gürtel, A-1090 Vienna, Austria. Address e-mail to stephan.kettner{at}akh-wien.ac.at

Thrombelastography (TEG®) appears to be a promising test to assess coagulation in infants and children. TEG® enables a rapid assessment of hemostatic function with only 300 µL of whole blood and provides information about plasmatic coagulation, platelet function, and fibrinolysis. In this study, we used TEG® to assess the coagulation system of preterm and term neonates to determine the effects of their deficient coagulation factor levels on global hemostatic function. Heparinase-modified TEG®, platelet and red blood cell count, plasma fibrinogen, and prothrombin time were assessed in four groups of clinically stable infants: severely preterm (gestational age [GA], 27–31 wk), moderately preterm (GA, 32–36 wk), term (GA, 36–40 wk), and former preterm (corrected GA, 34–40 wk). Healthy adult volunteers served as a control group. When compared with the adult group, thromboelastography revealed no defects in coagulation from groups of clinically stable infants, documenting the functional integrity of coagulation despite, in part, decreased conventional coagulation variables. Because clinically stable preterm and term infants show a relatively small incidence of bleeding, despite prolonged conventional coagulation tests, TEG® may better reflect the hemostatic potential of these patients compared with conventional coagulation tests.

IMPLICATIONS: This study assessed the coagulation of preterm and term infants by thrombelastography and found functional integrity of coagulation despite, in part, decreased conventional coagulation variables.

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				B. Haizinger, H. Gombotz, P. Rehak, G. Geiselseder, and R. Mair Activated thrombelastogram in neonates and infants with complex congenital heart disease in comparison with healthy children Br. J. Anaesth., October 1, 2006; 97(4): 545 - 552. [Abstract] [Full Text] [PDF]