The Thromboelastographic Profile at Birth in Very Preterm Newborns with Patent Ductus Arteriosus

Abstract

Background: The role of hemostasis in the closure of patent ductus arteriosus (PDA) in preterm infants is controversial. Objective: To assess thromboelastography (TEG) at birth in very-low-birth-weight (VLBW) infants affected by PDA. Methods: This was an ancillary study of a prospective observational study aimed at defining the TEG profile in healthy VLBW infants in the first month of life. In this analysis, we included neonates of < 33 weeks' gestational age (GA) with PDA and compared TEG traces based on (1) spontaneous closure versus the need for pharmacological treatment and (2) treatment response. We collected blood samples in the 1st day of life to perform recalcified native-blood TEG (reaction time, maximum amplitude, and lysis at 30 min [Ly30)]), standard coagulation tests, and a full blood count. Results: We enrolled 151 infants with a PDA at the first echocardiogram; 111 experienced spontaneous PDA closure while 40 required treatment. Mean GA was 29.7 ± 1.7 and 27.6 ± 2.1 weeks, and birth weight was 1,158 ± 256 and 933 ± 263 g in the 2 groups, respectively (p < 0.001). The hemostatic profile was similar between groups. Median hematocrit (44.6 and 48.7%; p = 0.01) and platelet count (187 and 216 × 10 3 /μL; p = 0.04) were lower in the treated group, although differences lost significance after controlling for GA and illness severity in the multivariate analysis. Responders to PDA treatment (n = 20) had a significantly lower median Ly30 than nonresponders (0 and 0.7%; p = 0.02). Conclusion: TEG at birth does not predict spontaneous PDA closure in preterm newborns. Fibrinolysis is enhanced in nonresponders to PDA treatment; this observation warrants further investigation.

Platelet Counts and Patent Ductus Arteriosus in Preterm Infants: An Updated Systematic Review and Meta-Analysis

“…The new search identified 20 articles (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) that were added to the 11 already included in our previous meta-analysis (19). The PRISMA flow diagram of the search process is shown in Supplementary Figure 1.…”

Individualized Bleeding Risk Assessment through Thromboelastography: A Case Report of May–Hegglin Anomaly in Preterm Twin Neonates

“…In pediatric cardio surgery, viscoelastic assays proved to optimize blood product use while reducing bleeding [28]. In the neonatal setting, viscoelastic tests have been used to evaluate neonates with bleeding, sepsis, and patent ductus arteriosus under pharmacological treatment [29][30][31].…”

Current Controversy on Platelets and Patent Ductus Arteriosus Closure in Preterm Infants

“…ADP, adenosine di-phosphate; GPIIb/IIIa, glycoprotein IIb/IIIa; PAC-1, procaspase activating compound 1 which detects activated GPIIb/IIIa. medical treatment exhibited signs of an enhanced fibrinolysis (46). While the exact mechanisms and the clinical consequences of these findings are yet to be examined, they further indicate a role of the neonatal coagulation system in ductal closure.…”

“…Recently, other investigators found lower PDGF levels in very immature infants (22-27 weeks) with failure of spontaneous DA closure (45). In addition, Ghirardello et al (46) assessed thromboelastography at birth in VLBW infants with PDA (n = 151). In their study, thromboelastography at birth did not predict persistence of PDA.…”