PB0258 - Haemostasis derangements in neonates with Hypoxic Ischemic Encephalopathy (HIE) compared with term neonates by using Rotational Thromboelastometry (ROTEM)

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

GM

Georgios Mitsiakos

Professor
2nd Neonatal Department and NICU, Aristotle University of Thessaloniki, "Papageorgiou" Hospital
THESSALONIKI, Thessaloniki, Greece

Co-Author(s)

DG

Dimitra Gialamprinou

Consultant Neonatologist
2nd Neonatal Department and NICU, Aristotle University of Thessaloniki, 'Papageorgiou" Hospital
Thessaloniki, Thessaloniki, Greece
AM

Athanasios Moraitis

Fellow in Neonatology
2nd Neonatal Department and NICU, Aristotle University of Thessaloniki, "Papageorgiou" Hospital
Thessaloniki, Thessaloniki, Greece
GK

Georgios Katsaras

Paediatrician
2nd Neonatal Department and NICU, Aristotle University of Thessaloniki, "Papageorgiou" Hospital
Thessaloniki, Thessaloniki, Greece
GK

Georgios Christos Kontovazainitis

Resident Doctor in Obstetrics & Gynaecology
2nd Neonatal Department and NICU, Aristotle University of Thessaloniki, "Papageorgiou" Hospital
Thessaloniki, Thessaloniki, Greece
IC

Ilias Chatziioannidis

Assistant Professor
2nd Neonatal Department and NICU, Aristotle University of Thessaloniki, "Papageorgiou" Hospital
Thessaloniki, Thessaloniki, Greece
EP

Efthimia Papacharalambous

Consultant of Neonatology
2nd Neonatal Department and NICU, Aristotle University of Thessaloniki, "Papageorgiou" Hospital
Thessaloniki, Thessaloniki, Greece
ED

Elisavet Diamanti

Professor, Director of 2nd Neonatal Department and NICU
2nd Neonatal Department and NICU, Aristotle University of Thessaloniki, "Papageorgiou" Hospital
Thessaloniki, Thessaloniki, Greece

Background: Hypoxic Ischemic Encephalopathy (HIE) caused by perinatal hypoxia in term neonates involves liver and bone marrow dysfunction and is associated with haemostasis impairment. Although the advent of therapeutic hypothermia (TH) offers neuroprotection, coagulation status evolves over the course of time with potential critical outcome. Data on coagulation disorders in neonates with HIE during TH are limited. Viscoelastic tests may be a bedside modality for studying the coagulation status of these neonates.

Aims: This single-center observational study aimed to assess the haemostatic status of neonates with HIE before, during and after TH compared to healthy term neonates.

Methods: Eight term neonates with moderate and severe HIE who underwent TH were included and compared with 20 healthy term neonates over a period of 24 months (01/2021 to 01/2023) by using extrinsic and fibrinogen ROTEM (EXTEM, FIBTEM) variables (CT; clotting time, CFT; clot formation time, A; amplitude, MCF; maximum clot firmness). Mann–Whitney test was used for the statistical analysis performed with SPSS statistics.

Results: Neonates under TH present prolonged CT in FIBTEM compared to that before TH and lower amplitudes and MCF in EXTEM, FIBTEM compared to those after the end of TH (Table 1). Neonates before TH compared to controls present prolonged CT, CFT and lower amplitudes and MCF in EXTEM, FIBTEM. Neonates under TH compared to controls present prolonged CT, CFT and lower amplitudes, MCF in EXTEM and prolonged CT in FIBTEM. Neonates after TH compared to controls present lower amplitudes and MCF in FIBTEM.

Conclusion(s): Neonates with HIE present hypocoagulable state with fibrinogen consumption progressively degenerated during TH which recovers while in rewarming. Improvement can be attributed to the disease recovery, medical management, cryoprecipitate administration and temperature regain. ROTEM seems to be reproducible point-of-care method in monitoring coagulation aberrations in neonatal HIE under TH management.