Evaluation of Platelet Contribution to Clot Strength in Neonates with Perinatal Hypoxia Using Rotational Thromboelastometry

Abstract: The hemostatic derangement of neonates with perinatal hypoxia is of multifactorial origin and may be attributed to ischemic tissue injury, acute blood loss, or disseminated intravascular coagulation. However, the pathophysiological mechanisms of thrombocytopenia, a common hematological finding in neonates with perinatal hypoxia, remain unclear. The aim of the present study was to evaluate the contribution of platelets to clot formation and clot strength in neonates with perinatal hypoxia using rotational thromboelastometry (ROTEM). This prospective cohort study included 139 neonates with perinatal hypoxia and 106 healthy neonates. Demographics and clinical findings were recorded, while hematological and biochemical tests, along with ROTEM, extrinsically activated test (EXTEM), and fibrin clot obtained by platelet inhibition with cytochalasin D (FIBTEM) assays, were performed in all study neonates. ROTEM parameters differed significantly between the two study groups; prolonged clotting time and clot formation time, lower clot amplitude at 10 minutes (A10) and maximum clot firmness (MCF) values, as well as lower PLTEM MCF (the difference between EXTEM MCF and FIBTEM MCF) and PLTEM MCE (the difference between EXTEM MCE and FIBTEM MCE) values were recorded in hypoxic neonates. Neonates with perinatal hypoxia demonstrate a hypocoagulable profile, with decelerated coagulation activation, reduced clot formation and stability, impaired fibrinolysis, and significantly reduced platelet contribution to clot dynamics.