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  • Clinical Research Article
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Assessment of hemostatic profile in neonates with necrotizing enterocolitis using Rotational Thromboelastometry (ROTEM)

Pediatric Research (2023)Cite this article

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.

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Fig. 1: The diagnostic capacity of ROTEM parameters in differentiating NEC from sepsis at the disease onset.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author (R.S.) on reasonable request.

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Author information

Author notes

  1. These authors contributed equally: Rozeta Sokou, Petros Mantzios.

Authors and Affiliations

  1. Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, Piraeus, Greece

    Rozeta Sokou, Stavroula Parastatidou, Georgios Ioakeimidis, Maria Lampridou & Aikaterini Konstantinidi

  2. Department of Internal Medicine, General Hospital of Eastern Achaia, Aigio, Greece

    Petros Mantzios

  3. Microbiology Department, “Saint Savvas” Oncology Hospital, Athens, Greece

    Andreas G. Tsantes

  4. Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Styliani Kokoris, Dimitra Houhoula, Aristeidis G. Vaiopoulos & Argirios E. Tsantes

  5. Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece

    Nicoletta Iacovidou

  6. Department of Biomedical Sciences, Humanitas University, Milan, Italy

    Daniele Piovani & Stefanos Bonovas

  7. IRCCS Humanitas Research Hospital, Milan, Italy

    Daniele Piovani & Stefanos Bonovas

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  1. Rozeta Sokou
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Contributions

R.S., A.E.T., and P.M. conceptualized the project. R.S., P.M., A.E.T., and A.G.T. designed the methodology. R.S., A.K., G.I., A.G.T., S.P., M.L., D.H., N.I., P.M., A.V., and S.K. were involved in data collection. AG.T, D.P., S.B., P.M., A.E.T., R.S., and A.K. were involved in analysis and data interpretation. A.E.T., R.S., A.GT., A.K., and P.M. wrote the manuscript. All the co-authors critically revised and finally approved the manuscript. All authors agree to be held accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Rozeta Sokou.

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Written informed consent has been obtained by parents or guardians of enrolled neonates.

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Sokou, R., Mantzios, P., Tsantes, A.G. et al. Assessment of hemostatic profile in neonates with necrotizing enterocolitis using Rotational Thromboelastometry (ROTEM). Pediatr Res (2023). https://doi.org/10.1038/s41390-023-02958-8

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  • DOI: https://doi.org/10.1038/s41390-023-02958-8

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