Assessment of hemostatic profile in neonates with necrotizing enterocolitis using Rotational Thromboelastometry (ROTEM)

• Published in: Pediatric research 2024-05, Vol.95 (6), p.1596-1602
• Main Authors: Sokou, Rozeta, Mantzios, Petros, Tsantes, Andreas G., Parastatidou, Stavroula, Ioakeimidis, Georgios, Lampridou, Maria, Kokoris, Styliani, Iacovidou, Nicoletta, Houhoula, Dimitra, Vaiopoulos, Aristeidis G., Piovani, Daniele, Bonovas, Stefanos, Tsantes, Argirios E., Konstantinidi, Aikaterini
• Format: Article
• Language: English
• Subjects: Birth weight; Case-Control Studies; Clinical Research Article; Diagnosis, Differential; Enterocolitis, Necrotizing - blood; Enterocolitis, Necrotizing - diagnosis; Female; Gestational Age; Hemostasis; Humans; Infant, Newborn; Infant, Premature; Intensive care; Intensive Care Units, Neonatal; Male; Medical diagnosis; Medicine; Medicine & Public Health; Neonatal care; Pediatric Surgery; Pediatrics; Sepsis; Sepsis - blood; Sepsis - diagnosis; Thrombelastography - methods
• ISSN: 0031-3998; 1530-0447; 1530-0447
• DOI: 10.1038/s41390-023-02958-8

Background This study aimed to explore the hemostatic profile of neonates with necrotizing enterocolitis (NEC) using Rotational Thromboelastometry (ROTEM) and to investigate if ROTEM parameters have the capacity to play a role in the differentiation of NEC from sepsis at the disease onset. Methods This observational study included 62 neonates (mean gestational age 31.6 weeks and mean birth weight 1620g) hospitalized in a neonatal intensive care unit. The neonates were categorized in three groups: neonates with NEC (Bell stage II and above), neonates with sepsis and healthy neonates and they were matched 1:1:1 with regards to gestational age, delivery mode, and sex. Clinical, laboratory data as well as measurements of ROTEM parameters at disease onset were recorded. Results ROTEM parameters differed between neonates with NEC and neonates with sepsis, indicating that NEC results in accelerated clot formation and higher clot strength compared to sepsis. The EXTEM CFT and A10 parameters demonstrated the highest diagnostic performance for NEC in terms of discrimination between NEC and sepsis (AUC, 0.997; 95% CI: 0.991–1.000 and 0.973; 95% CI: 0.932–1.000, respectively). Conclusions Neonates with NEC manifested accelerated clot formation and higher clot strength compared to septic and healthy neonates, as these were expressed by ROTEM parameters. Impact This work reports data on the hemostatic profile of neonates with necrotizing enterocolitis (NEC) using Rotational Thromboelastometry (ROTEM) and the capacity of ROTEM parameters in differentiating of NEC from sepsis at the disease onset. Neonates with NEC present acceleration of coagulation and exhibit a hypercoagulable profile, as this is expressed by ROTEM parameters, in comparison to septic and healthy neonates. ROTEM parameters demonstrated a good diagnostic capacity in differentiating NEC from sepsis at the disease onset.