title: Thromboelastography in term neonates: an alternative approach to evaluating coagulopathy.
abstract: OBJECTIVE
  To develop normative ranges for citrate-modified and heparinase-modified thromboelastography (TEG) in term neonates.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  An outborn neonatal and cardiac intensive care unit in a free-standing academic children's hospital.
  
  
  METHODS
  Thirty term neonates were enrolled as control subjects. Seventeen infants with clinically documented bleeding requiring blood transfusion were enrolled in the comparison group.
  
  
  METHODS
  Citrate-modified and heparinase-modified TEG parameters were calculated from blood specimens drawn via peripheral arterial stick or arterial line.
  
  
  RESULTS
  TEG in neonates differs from older children and adults; clotting time (R) and clot kinetics (K) values are generally lower while fibrinolysis or rate of clot breakdown (LY30) and coagulation index (CI) are often higher in neonates. TEG values in term neonates calculated as median (Q1-Q3) are as follows: R 4.150 (3.200-6.200), K 1.550 (1.200-1.800), α angle (α) 70.100 (66.000-72.900), maximum amplitude (MA) 61.850 (59.400-66.000), LY30 1.050 (0.100-1.600) and CI 1.950 (0.100 to 2.900). Cut points selected for optimal predictive value for bleeding using receiver operating curve analyses were R>6.3 (sensitivity 82.4%, specificity 80%); K>2.5 (sensitivity 82.4%, specificity 96.7%); α<59 (sensitivity 82.4%, specificity 96.7%); MA<57 (sensitivity 82.4%, specificity 86.7%); CI<-0.15 (sensitivity 88.2%, specificity 83.3%).
  
  
  CONCLUSIONS
  The reference ranges and cut points for citrate-modified and heparinase-modified TEG can be used to diagnose and evaluate coagulopathy in term neonates.
authors.affiliation: Divisions of Neonatology, Children's National Health Systems, Washington DC, USA.|Departments of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Sewell
authors.affiliation: Divisions of Neonatology, Children's National Health Systems, Washington DC, USA.|Departments of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.|Department of Neonatal-Perinatal Medicine, Children's Hospital of Montefiore, Bronx, New York, USA.
authors.forename: Katie R
authors.initials: KR
authors.lastname: Forman
authors.affiliation: Divisions of Laboratory Medicine, Children's National Health Systems, Washington DC, USA.|Departments of Pathology, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
authors.forename: Edward C C
authors.initials: EC
authors.lastname: Wong
authors.affiliation: Divisions of Laboratory Medicine, Children's National Health Systems, Washington DC, USA.
authors.forename: Meanavy
authors.initials: M
authors.lastname: Gallagher
authors.affiliation: Divisions of Laboratory Medicine, Children's National Health Systems, Washington DC, USA.|Departments of Pathology, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
authors.forename: Naomi L C
authors.initials: NL
authors.lastname: Luban
authors.affiliation: Divisions of Neonatology, Children's National Health Systems, Washington DC, USA.|Departments of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
authors.forename: An N
authors.initials: AN
authors.lastname: Massaro
mesh_terms: D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis*; D001780:Blood Coagulation Tests; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D011446:Prospective Studies; D047929:Term Birth / Q000097:blood*; D013916:Thrombelastography / Q000379:methods*
keywords: coagulation; neonate; reference range; thromboelastography