Effect of Therapeutic Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy on Platelet Function

Christensen, Robert D.; Sheffield, Mark J.; Lambert, D K; Baer, Vickie L.

doi:10.1159/000329818

Cited by 23 publications

(17 citation statements)

References 20 publications

(25 reference statements)

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“…Other TEG variables including clot reaction time and coagulation index also trended in a direction consistent with the hypothesis that hypothermia slows enzymatic activity and impairs the coagulation cascade. Of interest, MA, which reflects platelet activity, did not vary based on temperature although there is known cold inhibition on platelet function (34). It should be noted that TEG may be insensitive to mild qualitative platelet dysfunction and likely more sensitive to platelet count (i.e.…”

Section: Discussionmentioning

confidence: 99%

Effect of temperature on thromboelastography and implications for clinical use in newborns undergoing therapeutic hypothermia

et al. 2014

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BackgroundEncephalopathic neonates undergoing therapeutic hypothermia have increased risk for coagulopathy secondary to perinatal asphyxia and effects of cooling on the coagulation enzyme cascade. Thromboelastography (TEG) allows for a comprehensive assessment of coagulation that can be regulated for temperature. TEG has not been previously evaluated in newborns undergoing hypothermia treatment.MethodsEncephalopathic neonates treated with systemic hypothermia were enrolled in this prospective observational study. Daily blood specimens were collected for standard coagulation tests and platelet counts during hypothermia and after rewarming. Concurrent TEG assays were performed at 33.5°C and 37.0°C for comparison.ResultsA total of 48 paired TEGs from 24 subjects were performed. Mean (± SD) birthweight was 3.2±0.7 Kg, gestational age 38.4±1.4 weeks, and 40% were male. TEG results differed significantly between assays performed at 37.0°C versus 33.5°C, indicating more impaired coagulation at 33.5°C. TEG parameters K, α, MA and CI were significantly associated with clinical bleeding (p<0.05). These remained significant (except for MA) after controlling for transfusion therapy.ConclusionsTEG results are affected by temperature, consistent with the known association of hypothermia with coagulopathy. Several TEG parameters are predictive of clinical bleeding in newborns undergoing hypothermia. Selected cutpoints to predict bleeding risk are temperature dependent.

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Section: Discussionmentioning

confidence: 99%

Effect of temperature on thromboelastography and implications for clinical use in newborns undergoing therapeutic hypothermia

et al. 2014

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“…The capacity of platelets to form a hemostatically effective platelet plug [25] can be impaired in neonates receiving indomethacin [26] , ibuprofen (to a lesser extent) [27] , ampicillin [28,29] , inhaled nitric oxide [30] , or therapeutic hypothermia [31] . Moreover, large platelets function better than small platelets to form an effective platelet plug [24] .…”

Section: Guidelines For Administering Platelet Transfusions In the Nicumentioning

confidence: 99%

Platelet Transfusion in the Neonatal Intensive Care Unit: Benefits, Risks, Alternatives

Christensen¹

2011

Neonatology

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Platelet transfusions were introduced into clinical medicine about 60 years ago when they were shown to reduce the mortality rate of patients with leukemia who were bleeding secondary to hyporegenerative thrombocytopenia. In modern neonatology units, platelet transfusions are integral and indeed lifesaving for some neonates. However, the great majority of platelet transfusions currently administered in neonatal intensive care units (NICUs) are not given in the original paradigm to treat thrombocytopenic hemorrhage, but instead are administered prophylactically with the hope that they will reduce the risk of spontaneous bleeding. Weighing the risks and benefits of platelet transfusion, although imprecise, should be attempted each time a platelet transfusion is ordered. Adopting guidelines specific for platelet transfusion will improve consistency of care and will also generally reduce transfusion usage, thereby reducing costs and conserving valuable blood bank resources. Initiating specific programs to improve compliance with transfusion guidelines can further improve NICU transfusion practice.

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“…cTnI correlates strongly with the clinical grade of encephalopathy [7]. Hypothermia is linked to reduced cardiac output, peripheral vasoconstriction, sinus bradycardia, cardiac arrhythmias, hypotension, platelet dysfunction, and increased blood viscosity [8,9,10,11]. A study in newborn pigs showed a cardioprotective effect of hypothermia; whether this is also true in human infants is not clear [12].…”

Section: Introductionmentioning

confidence: 99%

Cardiac Biomarkers as Indicators of Hemodynamic Adaptation during Postasphyxial Hypothermia Treatment

Vijlbrief¹,

Benders²,

Kemperman

et al. 2012

Neonatology

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Background: Little is known about the effects of hypothermia on the cardiovascular system in term newborns with neonatal encephalopathy. Objectives: To evaluate whether mild hypothermia for neonatal encephalopathy is cardioprotective as indicated by the cardiac biomarkers cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP). Methods: This was an observational cohort study of infants treated for perinatal asphyxia. In infants, mild total body hypothermia treatment of 33.5°C during 72 h was initiated (n = 20). Samples of cTnI and BNP were collected before the start of hypothermia, at 24 and 48 h after birth, and after rewarming (84 h). BNP and cTnI values were then compared with BNP and cTnI values of asphyxiated infants not treated with hypothermia (n = 28). Results: No differences were found between the groups in clinical patient characteristics or inotropic support. The hypothermia-treated patients seemed to be clinically more affected (5-min Apgar score, p < 0.05; umbilical artery pH, p = 0.08), but showed similar encephalopathy scores. Significantly lower values for BNP were found in hypothermia- compared to nonhypothermia-treated infants at 48 h and at normothermia after rewarming [144 pmol/l (95–286) vs. 75 pmol/l (45–143), 182 pmol/l (73–341) vs. 43 pmol/l (24–163)]. No differences were found for cTnI concentrations between both groups. Conclusions: The raised, but similar, cTnI values between hypothermia- and nonhypothermia-treated infants indicate similar myocardial damage in both groups. The lower BNP levels during hypothermia treatment suggest that hypothermia after perinatal asphyxia exerts a beneficial effect on cardiac function.

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Effect of Therapeutic Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy on Platelet Function

Cited by 23 publications

References 20 publications

Effect of temperature on thromboelastography and implications for clinical use in newborns undergoing therapeutic hypothermia

Effect of temperature on thromboelastography and implications for clinical use in newborns undergoing therapeutic hypothermia

Platelet Transfusion in the Neonatal Intensive Care Unit: Benefits, Risks, Alternatives

Cardiac Biomarkers as Indicators of Hemodynamic Adaptation during Postasphyxial Hypothermia Treatment

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