Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Konstantinidi Aikaterini
Dissertation committee:
Νικολέττα Μ. Ιακωβίδου, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπουσα
Κουσκούνη Ευαγγελία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Γούναρης Αντώνιος, Ομότιμος Καθηγητής, Τμήμα Ιατρικής, Πανεπιστήμιο Θεσσαλίας
Τσαντές Αργύριος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βλάχος Νικόλαος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μπούτσικου Θεοδώρα, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ηλιοδρομίτη Ζωή, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Μεταβολές των παραμέτρων της θρομβοελαστογραφίας στα νεογνά με περιγεννητική υποξία-ασφυξία και πιθανή χρήση της μεθόδου ως προγνωστικός και θεραπευτικός δείκτης στα νεογνά αυτά.
Translated title:
Alterations of thromboelastographic variables in neonates with perinatal hypoxia/asphyxia and potential use of this method as prognostic and therapeutic biomarker for these neonates.
Summary:
Introduction: Perinatal hypoxia/asphyxia results in varying degrees of hypoxemia, ischemia, and finally metabolic acidosis. Compromised blood and oxygen supply disrupt the function of all the organs. The impact of these disorders on liver and bone marrow function leads to increased consumption of platelets and several coagulation factors, and subsequently to further derangement of the already immature neonatal hemostatic system. Therefore, perinatal hypoxia is related to increased risk of coagulopathy, the prevention -if possible- and timely management of which is of great importance. Thromboelastometry (TEM), a viscoelastic method evaluating the whole coagulation process dynamics, could be a reliable tool for studying the hemostatic status of neonates with perinatal hypoxia. Aim: The aim of this study was to assess the hemostatic profile of neonates with perinatal hypoxia through alterations of the parameters of extrinsically activated TEM-EXTEM assay, as well as to evaluate this method as a prognostic and a therapeutic biomarker for hypoxic neonates. Methods and materials: A total of 164 neonates with perinatal hypoxia/asphyxia, hospitalized in the NICU of Nikaia General Hospital, were included. Healthy neonates (n=273) born at the maternity ward of the same hospital served as controls. Hypoxic neonates were divided in two subgroups: 1) 16 neonates with perinatal asphyxia (according to the AAP and ACOG definition), and 2) 148 neonates with fetal distress. Demographics, clinical characteristics, and laboratory results were recorded for all of the study neonates. SNAPPE score (Score for Neonatal Acute Physiology Perinatal Extension) was calculated within the first 12 hours of admission and TEM-EXTEM test was performed during the first 3 days. Results: All the hypoxic neonates demonstrated a hypocoagulable profile, presenting with significantly prolonged CT, CFT and reduced A10, A20, A30, a angle and MCF, when compared to healthy neonates. EXTEM variables showed a more intense hypocoagulable profile in neonates with perinatal asphyxia in comparison to the neonates with fetal distress. Moreover, in hypoxic neonates, significant correlation was noted between EXTEM parameters and hepatic and renal function biomarkers (SGOT, LDH, ALBUMIN and Cr), platelets, and nucleated red blood cells. Finally, for hypoxic neonates, all EXTEM variables were significantly correlated with SNAPPE score and mortality. Conclusion: In neonates with hypoxia, hypocoagulability deriving from EXTEM parameters’ results, seems to be a promising biomarker for early detection of coagulation disorders, while the degree of hypocoagulability may correlate with the severity of hypoxia.
Main subject category:
Health Sciences
Keywords:
Neonatal haemostasis, Perinatal hypoxia, Fetal distress, Thromboelastography / thromboelastometry
Number of references:
156
