Register      Login

VOLUME 3 , ISSUE 1 ( January-March, 2024 ) > List of Articles


Hemostasis Assessment in Neonates: Evaluation of Viscoelastic Properties of Blood Clots

Brunetta Guaragni, Mario Motta

Keywords : Activated partial prothrombin time, Developmental hemostasis, Fibrinogen levels, Fibrinolytic activity, Natural anticoagulants, Platelet function, Procoagulant factors, Prothrombin time, Viscoelastic coagulation tests, von Willebrand factor

Citation Information : Guaragni B, Motta M. Hemostasis Assessment in Neonates: Evaluation of Viscoelastic Properties of Blood Clots. 2024; 3 (1):38-44.

DOI: 10.5005/jp-journals-11002-0089

License: CC BY-NC 4.0

Published Online: 26-03-2024

Copyright Statement:  Copyright © 2024; The Author(s).


In recent years, a new approach to neonatal hemostasis has been taking hold. The term “developmental hemostasis” refers to the dynamic, age-related physiological changes seen in the hemostatic system in neonates and young infants. Most conventional coagulation tests have limitations as these are focused primarily on the procoagulant factors and do not inform about platelet function and the levels/activity of von Willebrand factor (vWF), natural anticoagulants, and fibrinolytic activity. In this scheme, viscoelastic coagulation tests can rapidly provide a potentially useful, panoramic assessment of the entire coagulation process from the formation to degradation of clots, platelet function, and fibrinolysis. This is a narrative review on the use of viscoelastic tests in neonatal care; we have included information from our own clinical experience and from an extensive literature search spanning PubMed, Scopus, and Web of Science. This review is important because tests can help identify premature/critically ill infants who may be at risk of hemorrhage during routine care or after surgery and may need corrective transfusions with appropriate blood products.

PDF Share
  1. Wells M, Raja M, Rahman S. Point-of-care viscoelastic testing. BJA Educ 2022;22(11):416–423. DOI: 10.1016/j.bjae.2022.07.003.
  2. Tripodi A, Chantarangkul V, Mannucci PM. Acquired coagulation disorders: Revisited using global coagulation/anticoagulation testing. Br J Haematol 2009;147(1):77–82. DOI: 10.1111/j.1365-2141.2009.07833.x.
  3. Whiting D, DiNardo JA. TEG and ROTEM: Technology and clinical applications. Am J Hematol 2014;89(2):228–232. DOI: 10.1002/ajh.23599.
  4. Andrew M. The relevance of developmental hemostasis to hemorrhagic disorders of newborns. Semin Perinatol 1997;21(1): 70–85. DOI: 10.1016/s0146-0005(97)80022-5.
  5. Monagle P, Massicotte P. Developmental haemostasis: Secondary haemostasis. Semin Fetal Neonatal Med 2011;16(6):294–300. DOI: 10.1016/j.siny.2011.07.007.
  6. Andrew M, Paes B, Milner R, et al. Development of the human coagulation system in the full-term infant. Blood 1987;70(1):165–172. PMID: 3593964.
  7. Andrew M, Paes B, Milner R, et al. Development of the human coagulation system in the healthy premature infant. Blood 1988;72(5):1651–1657. PMID: 3179444.
  8. Christensen RD, Baer VL, Lambert DK, et al. Reference intervals for common coagulation tests of preterm infants (CME). Transfusion 2014;54(3):627–632. DOI: 10.1111/trf.12322.
  9. Meybohm P, Zacharowski K, Weber CF. Point-of-care coagulation management in intensive care medicine. Crit Care 2013;17(2):218. DOI: 10.1186/cc12527.
  10. Puetz J, Darling G, McCormick KA, et al. Fresh frozen plasma and recombinant factor VIIa use in neonates. J Pediatr Hematol Oncol 2009;31(12):901–906. DOI: 10.1097/MPH.0b013e3181c29c25.
  11. Motta M, Del Vecchio A, Perrone B, et al. Fresh frozen plasma use in the NICU: A prospective, observational, multicentred study. Arch Dis Child Fetal Neonatal Ed 2014;99(4):F303–F308. DOI: 10.1136/archdischild-2013-304747.
  12. Venkatesh V, Khan R, Curley A, et al. How we decide when a neonate needs a transfusion. Br J Haematol 2013;160(4):421–433. DOI: 10.1111/bjh.12095.
  13. Carroll PD, Christensen RD. New and underutilized uses of umbilical cord blood in neonatal care. Matern Health Neonatol Perinatol 2015;1:16. DOI: 10.1186/s40748-015-0017-2.
  14. Radicioni M, Mezzetti D, Del Vecchio A, et al. Thromboelastography: Might work in neonatology too? J Matern Fetal Neonatal Med 2012;(Suppl. 4):18–21. DOI: 10.3109/14767058.2012.714996.
  15. Radicioni M, Bruni A, Bini V, et al. Thromboelastographic profiles of the premature infants with and without intracranial hemorrhage at birth: A pilot study. J Matern Fetal Neonatal Med 2015;28(15):1779–1783. DOI: 10.3109/14767058.2014.968773.
  16. Amelio GS, Raffaeli G, Amodeo I, et al. Hemostatic evaluation with viscoelastic coagulation monitor: A Nicu experience. Front Pediatr 2022;10:910646. DOI: 10.3389/fped.2022.910646.
  17. Panigada M, Meli A, Scotti E, et al. Viscoelastic coagulation monitor as a novel device to assess coagulation at the bedside. A single-center experience during the COVID-19 pandemic. Asaio J 2021;67(3): 254–262. DOI: 10.1097/mat.0000000000001380.
  18. Radicioni M, Massetti V, Bini V, et al. Impact of blood sampling technique on reproducibility of viscoelastic coagulation monitor (VCM™) system test results in the neonate. J Matern Fetal Neonatal Med 2022;35(25):6998–7004. DOI: 10.1080/14767058.2021.1933935.
  19. Ghirardello S, Raffaeli G, Scalambrino E, et al. The intra-assay reproducibility of thromboelastography in very low birth weight infants. Early Hum Dev 2018;127:48–52. DOI: 10.1016/j.earlhumdev.2018.10.004.
  20. Edwards R, Naik–Mathuria B, Gay A, et al. Parameters of thromboelastography in healthy newborns. Am J Clin Pathol 2008;130(1):99–102. DOI: 10.1309/LABNMY41RUD099J2.
  21. Motta M, Guaragni B, Pezzotti E, et al. Reference intervals of citrated-native whole blood thromboelastography in premature neonates. Early Hum Dev 2017;115:60–63. DOI: 10.1016/j.earlhumdev.2017.09.014.
  22. Sewell E, Forman KR, Wong ECC, et al. Thromboelastography in term neonates: An alternative approach to evaluating coagulopathy. Arch Dis Child Fetal Neonatal Ed 2017;102(1):F79–F84. DOI: 10.1136/archdischild-2016-310545.
  23. Sokou R, Foudoulaki–Paparizos L, Lytras T, et al. Reference ranges of thromboelastometry in healthy full-term and pre-term neonates. Clin Chem Lab Med 2017;55(10):1592–1597. DOI: 10.1515/cclm-2016-0931.
  24. Sokou R, Konstantinidi A, Stefanaki C, et al. Thromboelastometry: Studying hemostatic profile in small for gestational age neonates—A pilot observational study. Eur J Nucl Med Mol Imaging 2019;178(4): 551–557. DOI: 10.1007/s00431-019-03331-w.
  25. Forman KR, Wong E, Gallagher M, et al. Effect of temperature on thromboelastography and implications for clinical use in newborns undergoing therapeutic hypothermia. Pediatr Res 2014;75(5): 663–669. DOI: 10.1038/pr.2014.19.
  26. Stammer AH, Willet L, Fristoe L, et al. Coagulation monitoring during extracorporeal membrane oxygenation: The role of thromboelastogram. J Extra Corp Technol 1995;27(3):137–145. PMID: 10155358.
  27. Phillips RC, Shahi N, Leopold D, et al. Thromboelastography-guided management of coagulopathy in neonates with congenital diaphragmatic hernia supported by extracorporeal membrane oxygenation. Pediatr Surg Int 2020;36(9):1027–1033. DOI: 10.1007/s00383-020-04694-0.
  28. Peterson JA, Maroney SA, Zwifelhofer W, et al. Heparin–protamine balance after neonatal cardiopulmonary bypass surgery. J Thromb Haemost 2018;16(10):1973–1983. DOI: 10.1111/jth.14245.
  29. Sokou R, Giallouros G, Konstantinidi A, et al. Thromboelastometry for diagnosis of neonatal sepsis-associated coagulopathy: An observational study. Eur J Pediatr 2018;177(3):355–362. DOI: 10.1007/s00431-017-3072-z.
  30. Sokou R, Piovani D, Konstantinidi A, et al. A risk score for predicting the incidence of hemorrhage in critically ill neonates: Development and validation study. Thromb Haemost 2021;121(2):131–139. DOI: 10.1055/s-0040-1715832.
  31. Venkatesh V, Curley A, Khan R, et al. A novel approach to standardised recording of bleeding in a high risk neonatal population. Arch Dis Child Fetal Neonatal Ed 2013;98(3):F260–F263. DOI: 10.1136/archdischild-2012-302443.
  32. Raffaeli G, Pesenti N, Cavallaro G, et al. Optimizing fresh-frozen plasma transfusion in surgical neonates through thromboelastography: A quality improvement study. Eur J Pediatr 2022;181(5):2173–2182. DOI: 10.1007/s00431-022-04427-6.
  33. Nogami K. The utility of thromboelastography in inherited and acquired bleeding disorders. Br J Haematol 2016;174(4):503–514. DOI: 10.1111/bjh.14148.
  34. Sorensen B, Ingerslev J. Whole blood clot formation phenotypes in hemophilia A and rare coagulation disorders. Patterns of response to recombinant factor VIIa. J Thromb Haemost 2004;2(1):102–110. DOI: 10.1111/j.1538-7836.2004.00528.x.
  35. Al Hawaj MA, Martin EJ, Venitz J, et al. Monitoring rFVIII prophylaxis dosing using global haemostasis assays. Haemophilia 2013;19(3): 409–414. DOI: 10.1111/hae.12110.
  36. Aghighi S, Riddell A, Lee C, et al. Global coagulation assays in hemophilia A: A comparison to conventional assays. Res Pract Thromb Haemost 2020;4(2):298–308. DOI: 10.1002/rth2.12295.
  37. Makris M, Oldenburg J, Mauser–Bunschoten EP, et al. The definition, diagnosis and management of mild hemophilia A: Communication from the SSC of the ISTH. J Thromb Haemost 2018;16(12):2530–2533. DOI: 10.1111/jth.14315.
  38. Bolton–Maggs PH, Pasi KJ. Haemophilias A and B. Lancet 2003;361(9371):1801–1809. DOI: 10.1016/S0140-6736(03)13405-8.
  39. Ramiz S, Hartmann J, Young G, et al. Clinical utility of viscoelastic testing (TEG and ROTEM analyzers) in the management of old and new therapies for hemophilia. Am J Hematol 2019;94(2):249–256. DOI: 10.1002/ajh.25319.
  40. Regling K, Kakulavarapu S, Thomas R, et al. Utility of thromboelastography for the diagnosis of von Willebrand disease. Pediatr Blood Cancer 2019;66(7):e27714. DOI: 10.1002/pbc.27714.
  41. Peyvandi F, Palla R, Menegatti M, et al. Coagulation factor activity and clinical bleeding severity in rare bleeding disorders: Results from the European Network of Rare Bleeding Disorders, J Thromb Haemost 2012;10(4):615–621. DOI: 10.1111/j.1538-7836.2012.04653.x.
  42. Meneghetti M, Palla R. Clinical and laboratory diagnosis of rare coagulation disorders (RCDs). Thromb Res 2020;196:603–608. DOI: 10.1016/j.thromres.2019.09.006.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.