title: The effect of inhaled nitric oxide therapy on thromboelastogram in newborns with persistent pulmonary hypertension.
abstract: Studies about the effects of inhaled nitric oxide (iNO) on bleeding time and platelet aggregation in newborns are limited in number and have inconclusive results. Thromboelastogram (TEG) shows the combined effects of coagulation factors and platelet functions. In this preliminary study, we aimed to evaluate the effects of iNO on coagulation using TEG in newborns with persistent pulmonary hypertension (PPH). TEG assays were performed in 10 term infants receiving iNO treatment for PPH and 32 healthy term infants. Samples of the iNO group were collected before and during iNO. Clot reaction time (R), clot kinetics (K), maximum amplitude (MA), and alpha angle were obtained from the TEG tracing. TEG-R values were statistically higher during iNO treatment (7.75 ± 3.34) when compared to the values before iNO (4.83 ± 1.38) and the healthy controls (3.75 ± 0.98). The alpha angle was lower in iNO treated infants at both periods (before iNO, 55.33 ± 8.58; during iNO, 42.90 ± 18.34) compared to the control group (64.95 ± 6.88). MA values before iNO treatment were the lowest (44.43 ± 14.09) and improved with the iNO treatment (48.40 ± 9.49) despite still being lower compared to the controls (53.67 ± 5.56).
  
  
  CONCLUSIONS
  Both PPH and iNO may negatively effect in vitro coagulation tests. Therefore, newborns with PPH requiring iNO treatment should be closely monitored for coagulation problems.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Ege University, Bornova, 35100, Izmir, Turkey, drsemarala@yahoo.com.
authors.forename: Sema
authors.initials: S
authors.lastname: Tanriverdi
authors.forename: Ozge Altun
authors.initials: OA
authors.lastname: Koroglu
authors.forename: Ozgun
authors.initials: O
authors.lastname: Uygur
authors.forename: Can
authors.initials: C
authors.lastname: Balkan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yalaz
authors.forename: Nilgun
authors.initials: N
authors.lastname: Kultursay
mesh_terms: D000280:Administration, Inhalation; D001777:Blood Coagulation / Q000187:drug effects*; D016022:Case-Control Studies; D045462:Endothelium-Dependent Relaxing Factors / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D009569:Nitric Oxide / Q000494:pharmacology* / Q000627:therapeutic use; D010547:Persistent Fetal Circulation Syndrome / Q000097:blood / Q000188:drug therapy*; D013916:Thrombelastography; D016896:Treatment Outcome
chemical_list: D045462:Endothelium-Dependent Relaxing Factors; D009569:Nitric Oxide