Hemostasis in Neonates with Perinatal Hypoxia—Laboratory Approach: A Systematic Review

Abstract

Birth asphyxia, with an estimated prevalence of 1 to 6 per 1,000 live births, may lead to multiorgan dysfunction due to impaired oxygen and/or blood supply to various organ systems, including the hemostatic system. Coagulopathy, a common complication of perinatal asphyxia, has been described since the 1960s. The aim of this study was to systematically review the literature for records on the use of hemostasis tests in the evaluation of coagulation disorders, in neonates who had suffered from perinatal hypoxia or asphyxia. We identified published studies by searching PubMed and Scopus, up until April 2022. The literature search retrieved 37 articles fulfilling the inclusion criteria of the review. According to the bibliography, thrombocytopenia is commonly associated with perinatal hypoxia/asphyxia. The thrombocytopenia is usually described as mild and platelets return to normal levels by the 10th day of life. Additionally, hypoxic neonates usually present with a hypocoagulable profile, as reflected by the prolongation of standard coagulation tests, including prothrombin time, activated partial thromboplastin time, and international normalized ratio, findings commonly associated with disseminated intravascular coagulation, and by the reduction of the levels of the physiologic inhibition of coagulation system. A few studies thus far using ROTEM/TEG in hypoxic neonates have come to the same conclusion as well; hypoxic newborns seem to be characterized by a hypocoagulable profile compared with healthy neonates. It should be emphasized, however, that standard coagulation tests provide only a rough estimation of the true bleeding or thrombotic risk of hypoxic neonates. On the contrary, viscoelastic methods seem to be more precise in the early detection of hemostasis disorders in the neonatal population. However, until now, there was uncertainty as to the most appropriate coagulation assays for diagnosis and management of coagulation derangement in neonates with perinatal hypoxia indicating the need for further research on this field.

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

“…It is acknowledged as a mandatory criterion for the definition of birth asphyxia [94,95]. Thromboelastometry studies focusing on neonates with perinatal hypoxia values are rare [96]. Konstantinidi et al detected higher LI60 values in hypoxic and asphyxiated infants when compared to controls [97].…”

Facteurs prédicteurs de la mortalité périnatale suite à l’asphyxie & environnement de naissance : étude cas-témoins

“…À la naissance les nouveau-nés affectés éprouvent une difficulté de l'adaptation avec leur nouvelle vie extra utérine, consistant en impossibilité d'assurer une ventilation normale [5,6]; une fois survenue, l'AP peut induire au décès précoce : soit en intra utérin, ou à la naissance après échec de réanimation. Les décès tardifs sont également enregistrés et sont dus essentiellement aux complications délétères de l' asphyxie elle-même ; chez les survivants, l'AP est souvent responsable d'une détresse vitale du nouveau-né, associant des anomalies respiratoires, cliniques multiviscérales, hémostatiques, et plus sévèrement neurologiques irréversibles, type d'encéphalopathie anoxo-ischémique et de paralysie cérébrale [2,4,5,7,8]. En se rapportant à « l'American Academy of Pediatrics » (AAP), et à « l'American College of Obstetricians and Gynecologists » (ACOG), le diagnostic de l'AP associe des critères cliniques et biologiques en l'occurrence : les anomalies du rythme cardiaque foetal (RCF), la dépression cardio-respiratoire et neurologique caractérisée par un score d'APGAR inférieur à 7 à la 5éme minute de vie , et une acidose métabolique sévère chiffrée par un pH du sang artériel <7 [6,9,10].…”

Perinatal mortality following perinatal asphyxia & birth environment: Case-control study

“…PA combines clinical and biological criteria such as fetal heart rate (FHR) abnormalities, cardiorespiratory and neurological depression (an APGAR score of less than 7 at 5 minutes of life), with evidence of acute hypoxia responsible for severe acidemia (arterial blood pH <7 and/or a base deficit ≥ 12 mmol/l) [1,4,5]. Consequently, PA can lead to various complications in newborns, including multi-organ failure, damage to the hemostatic system, anoxic-ischemic encephalopathy leading to cerebral palsy, and perinatal mortality [3,6,7,8,9]. The factors causing PA can have a maternal, fetal, or funicular origin.…”