The aim of the present study was to assess the coagulation profile in neonatal critical illness using rotational thromboelastometry (ROTEM), and to investigate its association with disease severity and its potential prognostic role in this clinical setting. Over a period of 67 months (July 2014–February 2020) 423 critically ill neonates with confirmed or suspected sepsis, perinatal hypoxia, or respiratory distress syndrome, hospitalized in our neonatal intensive care unit were included in the study. Demographic, clinical, and laboratory data were recorded on admission day and arterial blood was analyzed on ROTEM analyzer using the standard extrinsically activated rotational thromboelastometry assay (EXTEM). Neonatal illness severity scores (Modified NEOMOD [Neonatal Multiple Organ Dysfunction] and SNAPPE [Score for Neonatal Acute Physiology with Perinatal Extension]) were calculated at the same time as ROTEM analysis. Mortality during in-hospital stay was the main outcome measure. Multivariable analyses showed that a 10 mm decrease in EXTEM clot amplitude recorded at 10 minutes (A10) is significantly associated with a higher mortality (odds ratio [OR] = 1.69, 95% confidence interval [CI]: 1.33–2.08). Higher modified NEOMOD (OR = 1.36, 95% CI: 1.26–1.47) and higher SNAPPE scores (OR = 1.06, 95% CI: 1.04–1.08) were also associated with increased mortality. The CT and A10 variables demonstrated the best prognostic performance among the EXTEM parameters for mortality (area under the curve [AUC] = 0.78; 95% CI: 0.69–0.86 and AUC = 0.76; 95% CI: 0.66–0.85, respectively), showing an optimal cut-off CT ≥63 seconds and A10 ≤37 mm. Using optimal cut-off values of the EXTEM parameters for prediction of mortality, neonates with CT ≥63 seconds were 7.4 times more likely to die (OR = 7.40, 95% CI: 3.50–15.65), while neonates with A10 ≤37 mm were 5.8 times more likely to die (OR = 5.88, 95% CI: 2.94–12.50). An EXTEM hypocoagulable profile on disease onset was shown to be an independent risk factor for in-hospital mortality in neonatal critical illness.

本研究的目的是使用旋转血栓弹力图 (ROTEM) 评估新生儿危重疾病的凝血情况，并研究其与疾病严重程度的关系及其在该临床环境中的潜在预后作用。在 67 个月（2014 年 7 月至 2020 年 2 月）期间，423 名在我们新生儿重症监护病房住院的确诊或疑似败血症、围产期缺氧或呼吸窘迫综合征的危重新生儿被纳入研究。在入院当天记录人口统计学、临床和实验室数据，并在 ROTEM 分析仪上使用标准外激活旋转血栓弹性测定法 (EXTEM) 分析动脉血。在 ROTEM 分析的同时计算新生儿疾病严重程度评分（改良的 NEOMOD [新生儿多器官功能障碍] 和 SNAPPE [围产期延长的新生儿急性生理学评分]）。住院期间的死亡率是主要的结局指标。多变量分析表明，在 10 分钟 (A10) 记录的 EXTEM 凝块振幅减少 10 mm 与较高的死亡率显着相关（优势比 [OR] = 1.69，95% 置信区间 [CI]：1.33-2.08）。较高的改良 NEOMOD (OR = 1.36, 95% CI: 1.26-1.47) 和较高的 SNAPPE 评分 (OR = 1.06, 95% CI: 1.04-1.08) 也与死亡率增加有关。CT 和 A10 变量在 EXTEM 参数中对死亡率的预后性能最好（曲线下面积 [AUC] = 0.78；95% CI：0.69–0.86 和 AUC = 0.76；95% CI：0.66–0.85，分别），显示最佳截止 CT ≥63 秒和 A10 ≤37 mm。使用 EXTEM 参数的最佳截止值来预测死亡率，CT ≥63 秒的新生儿死亡的可能性增加了 7.4 倍（OR = 7.40，95% CI：3.50-15.65），而 A10 ≤37 mm 的新生儿死亡的可能性为死亡可能性增加 5.8 倍（OR = 5.88，95% CI：2.94–12.50）。疾病发作的 EXTEM 低凝状态被证明是新生儿危重病住院死亡率的独立危险因素。