Changes in primary and secondary hemostasis as a predictor of adverse neonatal outcomes in birth asphyxia

Abstract

The hemostatic system is complex and evolves continuously since gestation and well into the adult years, in a process known as “developmental hemostasis”. This article presents information about the functioning of the hemostatic system in normal and pathological conditions (birth asphyxia) in newborns, reflects fundamental differences in hemostatic functioning during the neonatal period and the possibilities in maintaining normal hemostasis in conditions of physiological deficiency of both clotting factors and the anticoagulant system. The article highlights various methods of diagnosing the hemostatic system used in neonatology. The so-called global hemostasis tests are being introduced into neonatal practice. The study of hemostasis using thromboelastography technique allows to correct for the patient's real body temperature and estimate both the interaction of platelets and clotting factors and examine the plasma hemostasis component in isolation. The effects of neonatal asphyxia and therapeutic hypothermia procedures on the hemostatic system are poorly understood. This review article attempts to summarize the data available in the world scientific literature concerning this problem. Key words: newborns, developing hemostasis, asphyxia, hypoxic-ischemic encephalopathy, thromboelastography, coagulation, therapeutic hypothermia