Thromboelastography: might work in neonatology too?

Aim: To review the working principles of thromboelastography and evaluate the current knowledge about the possibility of its implementation in the neonatal intensive care unit setting. Method: Thorough search of the literature in the PubMed database (until May 31, 2012) concerning Thromboelastography (TEG) and/or Thromboelastometry (ROTEM) use in the newborn infant. Results: Neonatal data are limited to a small number of healthy subjects and virtually absent in the extreme premature infant. Healthy newborns exhibit age dependent accelerated initiation and propagation of coagulation despite prolonged standard plasma coagulation test results, whereas clot firmness and fibrinolysis are similar to adult values. Several neonatal pathological conditions (e. g. sepsis; hypothermia) are linked with substantial changes in the thromboelastographic parameters. Conclusions: The current knowledge is too limited to express a definitive indication on the reliability of the use of viscoelastic point of care analyzer in the neonatal intensive care unit setting. However, their potential use not only as a diagnostic tool, but also to guide the transfusion therapy requires careful consideration.