Establishing reference ranges of cord blood: point-of-care hemostatic function assessment in preterm and term neonates.

BACKGROUND: Thrombelastometry, allowing timely assessment of global hemostatic function, is increasingly used to guide hemostatic interventions in bleeding patients. Reference values are available for adults and children, including infants but not neonates immediately after birth. METHODS: Neonates were grouped as preterm (30 + 0 to 36 + 6 weeks/days) and term (37 + 0 to 39 + 6 weeks/days). Blood samples were drawn from the umbilical cord immediately after cesarean section and analyzed by thrombelastometry. Reference ranges were determined for the extrinsic and intrinsic coagulation pathways, fibrin polymerization, and hyperfibrinolysis detection. RESULTS: All extrinsically activated test parameters, but maximum lysis (P = 0.139) differed significantly between both groups (P ≤ 0.001). Maximum clot firmness in the fibrin polymerization test was comparable (P = 0.141). All intrinsically activated test parameters other than coagulation time (P = 0.537) and maximum lysis (P = 0.888) differed significantly (P < 0.001), and so did all aprotinin-related test parameters (P ≤ 0.001) but maximum lysis (P = 0.851). CONCLUSIONS: This is the first study to identify reference ranges for thrombelastometry in preterm and term neonates immediately after birth. We also report differences in clot initiation and clot strength in neonates born <37 versus ≤40 weeks of gestation, mirroring developmental hemostasis. IMPACT: Impact: This prospective observational study is the first to present reference ranges in preterm and term infants for all types of commercially available tests of thrombelastometry, notably also including the fibrin polymerization test. IMPORTANCE: Viscoelastic coagulation assays such as thrombelastometry have become integral to the management of perioperative bleeding by present-day standards. Reference values are available for adults, children, and infants but not for neonates. Key message: Clot initiation and formation was faster and clot strength higher in the term than in the preterm group. Parameters of thrombelastometry obtained from cord blood do not apply interchangeably to preterm and term neonates.

Cost analysis of two approaches to parenteral nutrition in critically ill children.

OBJECTIVE: In pediatric intensive care, two approaches to parenteral nutrition are available: individualized admixtures or commercial standard solutions. Even though individualized admixtures can be tailored to sometimes highly intricate requirements, standard solutions are able to meet the demands of the majority of pediatric patients. To address the growing importance of costs in intensive care, we investigated whether relevant differences between individualized admixtures and standard solutions in terms of costs can be found. DESIGN: Retrospective analysis. SETTING: University-affiliated intensive care unit. PATIENTS: Fifty consecutively admitted pediatric patients requiring parenteral nutrition. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Comparison of actual costs of individualized admixtures and theoretical costs of standard solutions. Mean actual costs of individualized admixtures of Euro 81.78 (+/- 16.33) per patient and day were significantly higher than the theoretical costs of standard solutions of Euro 61.21 (+/- 6.55). Cost differences increased with patients' body weights. CONCLUSIONS: Parenteral nutrition with standard solutions offers the potential of a relevant cost reduction compared with individualized admixtures in critically ill children.