Observational study of haemostatic dysfunction and bleeding in neonates with hypoxic–ischaemic encephalopathy

Pakvasa, M; Winkler, Anne; Hamrick, Shannon E. G.; Josephson, Cassandra D.; Patel, Ravi

doi:10.1136/bmjopen-2016-013787

Cited by 31 publications

(22 citation statements)

References 20 publications

(28 reference statements)

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“…9 Based on the comparison between the hypoxic and healthy neonates in this study, a potentially hypocoagulable profile in hypoxic neonates was detected. This finding is consistent with the results of Pakvasa et al, 11 who measured PT, platelet count, and fibrinogen in neonates with moderate-to-severe HIE. Moreover, Suzuki and Morishita 20 found plasma levels of thrombin-antithrombin complexes, D-dimer, fibrin(ogen) degradation products, and soluble fibrin monomer complexes markedly higher in the umbilical cord blood of asphyxiated newborns than in healthy neonates and El Beshlawy et al 21 reported a marked decrease of antithrombin, protein C, and protein S in asphyxiated neonates, both noting high incidence of DIC in their study population.…”

Section: Discussionsupporting

confidence: 93%

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Thromboelastometry Variables in Neonates with Perinatal Hypoxia

Konstantinidi

Sokou

Tsantes

et al. 2020

Semin Thromb Hemost

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Perinatal hypoxia is associated with an increased risk of coagulation disorders by enhancing the consumption of platelets and some clotting factors due to the associated severe hypoxemia, acidemia, and compromised oxygen and blood supply to the neonatal liver and bone marrow. Thromboelastometry (TEM), which estimates the dynamics of blood coagulation, may represent an attractive tool for studying the coagulation status of these neonates. We aimed at assessing the hemostatic profile of neonates with perinatal hypoxia using the standard extrinsically activated TEM (ex-TEM) assay. In total, 164 hospitalized neonates with perinatal asphyxia and/or fetal distress comprised the study subjects, and 273 healthy neonates served as controls. Ex-TEM assay was performed, SNAPPE (Score for Neonatal Acute Physiology Perinatal Extension) was calculated, and clinical findings and laboratory results were recorded in all study subjects. Hypoxic neonates expressed a prolonged clotting time (CT) and clot formation time (CFT) and reduced amplitude at 10 minutes (A10), α-angle, and maximum clot firmness compared with healthy neonates. Furthermore, asphyxiated neonates had a significantly prolonged CT and CFT and reduced A10 and α-angle compared with neonates with fetal distress. Hypoxic neonates demonstrate a hypocoagulable ex-TEM profile relative to healthy neonates, indicating a potential role of TEM in the early detection of coagulation derangement in perinatal hypoxia.

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Section: Discussionsupporting

confidence: 93%

“…Few data exist in the literature on the study of hemostatic derangements using viscoelastic tests in asphyxiated neonates or in neonates with fetal distress. [9][10][11] We therefore aimed at investigating the hemostatic profile of neonates with perinatal hypoxia using TEM.…”

mentioning

confidence: 99%

Thromboelastometry Variables in Neonates with Perinatal Hypoxia

Konstantinidi

Sokou

Tsantes

et al. 2020

Semin Thromb Hemost

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“…Although moderate hypothermia can be therapeutic in term neonates following intrauterine hypoxemic/ischemic brain injury, hypothermia in premature neonates is associated with worse outcomes . In addition, hypoxemic/ischemic brain injury has been found to be independently associated with coagulopathy . Lester et al found that hypothermia in adult transfusion recipients was associated with increased blood product consumption and higher mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Evaluating emergency‐release blood transfusion of newborn infants at the Intermountain Healthcare hospitals

et al. 2019

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BACKGROUND: An emergency-release blood transfusion (ERBT) protocol (uncrossmatched type O-negative red blood cells, AB plasma, AB platelets) is critical for neonatology practice. However, few reports of emergency transfusions are available. We conducted an ERBT quality improvement project as a basis for progress. STUDY DESIGN AND METHODS:For each ERBT in the past 8 years, we logged indications, products, locations and timing of the transfusions, and outcomes. ABBREVIATIONS: CPDA-1 = citrate phosphate dextrose adenine 1; ERBT = emergency-release blood transfusion; IRB = Institutional Review Board; NICU = neonatal intensive care unit; QI = quality improvement; REDCap = Research Electronic Data Capture. From the ERBT = emergency-release blood transfusion; IVH = intraventricular hemorrhage; UAC = umbilical artery catheter; UVC = umbilical venous catheter.

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“…In a recent study by Pakvasa et al . (), there were notable haemostatic defects in patients with moderate to severe hypoxic ischaemic encephalopathy (HIE). This correlated with an increased risk of bleeding, although the authors did not assess survival.…”

Section: Discussionmentioning

confidence: 99%

Bleeding emergencies in neonatal and paediatric patients: improving the quality of care using simulation

Delaney

Roberts

Mazor

et al. 2018

Transfusion Medicine

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Objectives: Using a multidisciplinary approach and simulation, a massive transfusion process (MTP) was developed to care for patients in need of emergency transfusion. It was then assessed for effectiveness.Background: After a series of sentinel emergency bleeding events, a reliable process for hospital staff to deliver appropriate blood products and obtain relevant laboratory tests to guide therapy for patients with emergency bleeding was needed. Methods:To determine the feasibility of the new MTP, multidisciplinary teams participated in simulation events. Each simulation event helped refine the MTP. A special laboratory testing panel was devised. To judge the effectiveness and timeliness of the MTP, process measures and patient survival was retrospectively evaluated during the time period before and after MTP implementation. Results:A new emergency bleeding panel of laboratory tests significantly decreased the turn-around time for fibrinogen, haematocrit, International normalised ratio (INR) and platelet count. The speed of commencing the first red blood cells transfusion was also improved (2:00 h vs 0:20 min, P = 0·001). Of 78 patients, there was no change in survival before (n = 31, 48·4%) and after (n = 47, 42·6%; P = 0·6478) MTP implementation. However, there was significant improvement in survival associated with MTP events on the weekdays. Conclusions:A reliable emergency transfusion process consists of an automatic chain of events that keeps decision-making to a minimum and leads to the fast procurement of blood products and salient test results. This work shows that a multidisciplinary iterative process using simulation increases the efficiency of clinical care delivery for bleeding paediatric and neonatal patients.

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Observational study of haemostatic dysfunction and bleeding in neonates with hypoxic–ischaemic encephalopathy

Cited by 31 publications

References 20 publications

Thromboelastometry Variables in Neonates with Perinatal Hypoxia

Thromboelastometry Variables in Neonates with Perinatal Hypoxia

Evaluating emergency‐release blood transfusion of newborn infants at the Intermountain Healthcare hospitals

Bleeding emergencies in neonatal and paediatric patients: improving the quality of care using simulation

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