Assessment of Hemostatic Profile in Neonates with Intrauterine Growth Restriction: A Systematic Review of Literature

Abstract

Intrauterine growth restriction (IUGR) affects nearly 10 to 15% of pregnancies and is responsible for many short- and long-term adverse consequences, including hemostatic derangement. Both thrombotic and hemorrhagic events are described in the perinatal period in these neonates. The aim of this study was to systematically review the literature on the laboratory studies used to evaluate the hemostatic system of the IUGR small for gestational age neonate. We reviewed the current literature via PubMed and Scopus until September 2022. Following our inclusion/exclusion criteria, we finally included 60 studies in our review. Thrombocytopenia, characterized as hyporegenerative and a kinetic upshot of reduced platelet production due to in utero chronic hypoxia, was the main finding of most studies focusing on growth-restricted neonates, in most cases is mild and usually resolves spontaneously with the first 2 weeks of life. In regard to coagulation, growth-restricted newborns present with prolonged standard coagulation tests. Data regarding coagulation factors, fibrinolytic system, and anticoagulant proteins are scarce and conflicting, mainly due to confounding factors. As thromboelastography/rotational thromboelastometry (TEG/ROTEM) provides a more precise evaluation of the in vivo coagulation process compared with standard coagulation tests, its use in transfusion guidance is fundamental. Only one study regarding TEG/ROTEM was retrieved from this population, where no difference in ROTEM parameters compared with appropriate for gestational age neonates was found. Despite the laboratory aberrations, no correlation could be achieved with clinical manifestations of bleeding or thrombosis in the studies included. More studies are needed to assess hemostasis in IUGR neonates and guide targeted therapeutic interventions.

Hemostatic Profile of Intrauterine Growth-Restricted Neonates: Assessment with the Use of NATEM Assay in Cord Blood Samples

“…Prolonged PT, INR, and APTT have been observed in IUGR infants, mainly attributed to reduced production of clotting factors [15,[26][27][28][29]87]. As clotting factors do not cross the placenta, they are produced mainly in the fetal liver, a process affected in IUGR fetuses due to in utero hypo oxygenation and subsequent fetal liver dysfunction [90]. LI60 represents the clot remaining at 60 min, meaning that higher LI60 values spotted in the IUGR neonates of our study designate a hypo fibrinolytic profile, compared to the control group.…”

“…The hypocoagulable predisposition of IUGR infants, as depicted by prolonged PT, INR, and APTT, is noted in studies regarding standard coagulation tests [15,[26][27][28][29]88]. Nevertheless, the link between laboratory assessment and clinical manifestation is yet to be determined [29,87,90]. IUGR is associated with hemorrhagic complications such as pulmonary hemorrhage, gastrointestinal bleeding, and hemorrhagic neonatal stroke [7,10,11,13].…”

Editorial Compilation XIV

“…Next, Thachil and colleagues ask the question: “Are antiphospholipid antibodies a surrogate risk factor for thrombosis in sepsis?” in a Commentary on this topic. 13 As also discussed by Radin et al in this issue, 1 APS is a hypercoagulable state caused by antiphospholipid antibodies (aPLs). APS clinically manifests with arterial or venous or microvascular thrombi and/or pregnancy complications.…”

“…This issue begins with a couple of reviews focused on disorders of hemostasis in the young. 1 2 First, Karapati and colleagues review the hemostatic profile of neonates with intrauterine growth restriction (IUGR). IUGR affects nearly 10 to 15% of pregnancies and is responsible for many short- and long-term adverse consequences, including hemostatic derangement.…”