NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
Arch Dis Child Fetal Neonatal Ed. 2020 Jul;105(4):412-418. doi: 10.1136/archdischild-2019-317860. Epub 2019 Nov 8.
We determined thromboelastographic (TEG) profiles of healthy very low birthweight infants (VLBWIs) of the day of birth and at set intervals during their first month.
Prospective observational study with blinded clinical and laboratory follow-up.
Level III neonatal intensive care unit (June 2015 to June 2018).
Consecutive qualifying VLBWIs were enrolled at birth and followed up for 30 days.
Laboratory (citrated-native TEG, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, blood count) and clinical variables were retrieved at birth, 3rd-5th, 10th and 30th day of life. Blood samples temporally related to events with a potential hemostatic impact (sepsis, bleeding, platelets/plasma transfusions, ibuprofen/indomethacin administration) were excluded from analysis.
We enrolled 201 VLBWIs and 72 full-term neonates. Sixty-seven of the healthy VLBWIs completed the 30-day follow-up. 541 TEG traces were analysed.On day 1, the median (minimum-maximum) TEG values were as follows: reaction time (R), 8.2 min (1-21.8); kinetics (K), 2.8 min (0.8-16); α angle, 51° (14.2-80.6); maximum amplitude (MA), 54.9 mm (23.9-76.8). PT and APTT were 15.9 s (11.7-51.2) and 59 s (37.8-97.5), respectively. The above parameters suggest minor hypocoagulability compared with term infants. On day 30, the median (minimum-maximum) R was 5 (1-16.9), K 1 (0.8-4.1), α 74.7 (41.1-86.7) and MA 70.2 (35.8-79.7). PT and APTT were 12.1 (10.4-16.6) and 38.8 (29.6-51.4), respectively. Those parameters are consistent with a relatively hypercoagulable phenotype, compared with term infants.
Healthy VLBWIs have a prolonged PT and APTT, but their TEG profiles suggest a relatively balanced hemostatic system, with slight hypocoagulability initially (compared with term neonates), gradually evolving to a somewhat more procoagulant phenotype over the first month.
我们测定了刚出生的极低出生体重儿（VLBWI）和出生后第一个月内不同时间点的血栓弹力图（TEG）特征。
前瞻性观察性研究，对临床和实验室数据进行盲法随访。
三级新生儿重症监护病房（2015 年 6 月至 2018 年 6 月）。
连续符合纳入标准的 VLBWI 在出生时入组，并随访 30 天。
在出生时、第 3-5 天、第 10 天和第 30 天，采集实验室（枸橼酸钠-本地 TEG、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原、血常规）和临床变量数据。与潜在止血影响相关的事件（脓毒症、出血、血小板/血浆输注、布洛芬/吲哚美辛给药）的血样均从分析中排除。
我们共纳入 201 例 VLBWI 和 72 例足月新生儿。67 例健康 VLBWI 完成了 30 天的随访。共分析了 541 条 TEG 曲线。在第 1 天，TEG 的中位数（最小值-最大值）值如下：反应时间（R）8.2 分钟（1-21.8）；动力学（K）2.8 分钟（0.8-16）；α角 51°（14.2-80.6）；最大振幅（MA）54.9 毫米（23.9-76.8）。PT 和 APTT 分别为 15.9 秒（11.7-51.2）和 59 秒（37.8-97.5）。与足月儿相比，上述参数提示存在轻微低凝状态。在第 30 天，R 的中位数（最小值-最大值）为 5（1-16.9），K1 为 0.8-4.1，α为 74.7（41.1-86.7），MA 为 70.2（35.8-79.7）。PT 和 APTT 分别为 12.1（10.4-16.6）和 38.8（29.6-51.4）。与足月儿相比，这些参数表明凝血酶时间和活化部分凝血活酶时间相对延长，且存在相对高凝表型，最初（与足月儿相比）存在轻微低凝，随后在第一个月逐渐向更促凝表型演变。
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