- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04917965
Thromboelastographic Profile in Healthy Newborns and Infants of Diabetic Mothers Using TEG6s
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Thromboelastography (TEG), is a laboratory technique used to examine the process of clot formation and degradation by measuring and reporting the kinetic changes, the rate of clot formation, clot strength, and clot stability in umbilical cord blood samples. TEG provides numeric values and a graphical representation of the primary and secondary hemostatic systems and fibrinolysis. The current standard assessments of coagulation status require a combination of multiple tests with multiple blood samples. These tests, including prothrombin time (PT), partial thromboplastin time (aPTT), fibrinogen level, and platelet count, only partially reflect components of the coagulation system, whereas TEG reflects the complex interplay between coagulation factors, cellular components, enzymes, and highly organized feedback mechanisms that maintain equilibrium between clot formation and lysis. TEG has advantages over routine coagulation studies because it is able to assess coagulation function more quickly and with a single smaller blood sample.
A few studies, however, have established normative TEG results in newborns. These studies used older TEG systems/technology. There is a newer TEG6s platform which is currently available at Arkansas Children's Hospital (ACH) and only 3 other children's hospitals in the country. Normative values using TEG6s have not been established in healthy neonates. In fact, although there are investigations in adults, there are no published studies using this newer technology in newborns. The lack of normative standards for TEG6s in newborns is limiting the use of this technology in research and clinical practice.
TEG6s simplifies and standardizes the technique for performing TEG by eliminating the need for manual pipetting. This platform also enables multiple assays to be performed simultaneously from a single blood sample. The TEG6s measures clot viscoelasticity throughout the coagulation process by using resonance technology. Using light-emitting diode illumination, an infrared detector measures vertical motion of the coagulating blood meniscus. Greater clot strength causes higher resonant frequencies, which is subsequently identified by the detector and converted to a graphical image. The TEG6s can deliver the same quality test results without the complicated test preparation process required when using the older TEG platform.
There are a number of well-established perinatal risk factors for thrombosis in the newborn, including systemic infections, dehydration, congenital heart disease, birth asphyxia, polycythemia, presence of intravascular catheters, inherited thrombophilias, and transplacental passage of maternal antiphospholipid and anticardiolipin antibodies. Described since at least 1965, however, maternal diabetes is the most frequently identified risk factor. This risk of thrombosis in infants of diabetic mothers (IDM) has been found to be 15.8% compared with <1% in the non-IDM group. Despite the well-established hypercoagulable state observed in IDMs, there have been no studies evaluating TEG in these newborns.
Currently, there are few published studies on TEG as it relates to neonates. The clotting profile in neonates differs vastly from adults and even the pediatric population, explaining why prior data on TEG from these populations cannot be extrapolated to this special population of newborns. The significant difference is likely explained by the delicate balance in the neonatal hemostatic system that is composed of lower levels of plasma coagulation inhibitors, such as antithrombin, protein C, and protein S, while having procoagulant factor levels, such as factor VIII, von Willebrand factor (vWF), and factor XIII levels that are comparable to the levels in adults.
There have been prior studies establishing normative values for TEG in term newborns but none with the new TEG6s platform. Furthermore, there have been minimal studies looking into the diverse subgroups of the neonatal population on either TEG or TEG6s. With regards to my proposed project, TEG is likely to identify differences among healthy newborns and IDMs, which will help explain the propensity to clot and guide further research into prevention and treatment of this complication.
The study of coagulation currently entails multiple tests, requires multiple blood samples, and has a waiting period for laboratory results. Large volumes of repeated blood sampling in this physically small-sized population can lead to iatrogenic anemia. TEG6s, however, uses a single blood sample to deliver results quickly with both a graphical representation and numeric value. The results provided by TEG are useful in helping to determine specific deficiencies affecting a patient, for example, clotting factors, heparin, fibrinogen and platelets.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Contact
- Name: Alexandra G Woodle, MD
- Phone Number: 9548161411
- Email: agwoodle@uams.edu
Study Locations
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-
Arkansas
-
Little Rock, Arkansas, United States, 72202
- Arkansas Children's Hospital
-
Contact:
- Alexandra Woodle, MD
- Phone Number: 954-816-1411
- Email: Agwoodle@uams.edu
-
Contact:
- David Matlock, MD
- Email: dmatlock@uams.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Mothers delivering or scheduled to deliver at the Labor and Delivery unit at UAMS when study personnel are available will be approached to discuss participation if they meet criteria for enrollment.
A control group will include neonates ≥37 weeks gestational age on day of life 1 born to mothers with uncomplicated pregnancies and a comparison group that will include neonates ≥37 weeks gestational age on day of life 1 born to mothers with gestational diabetes or a history of Type 1 or Type 2 diabetes prior to pregnancy, either requiring insulin or diet controlled. The control group will include 20 subjects, and the comparison group will include 20 subjects.
Description
Inclusion Criteria:
Control Group: Healthy term neonates
- Infants born at 37 weeks gestational age or greater born to mothers of any age with uncomplicated pregnancies
Comparison Group: Term infants of diabetic mothers
- Infants born at 37 weeks gestational age or greater to mothers of any age with gestational diabetes or Type 1 or Type 2 diabetes, managed with either diet or insulin
Exclusion Criteria:
For Both Groups:
- Infants <37 weeks gestational age
- Multiple gestation pregnancies
- Maternal thrombocytopenia
- Known fetal anomalies
- Known maternal blood clotting disorders or history of thrombosis
- Known family history of clotting disorders
- Chorioamnionitis (diagnosed prior to delivery)
For "Healthy Term Neonates"
- Intrauterine growth restriction
- Gestational hypertension, chronic hypertension, pre-eclampsia, and/or eclampsia
- Any other major complication of pregnancy or major medical history
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Healthy Term Neonates
Infants born at 37 weeks gestational age or greater born to mothers of any age with uncomplicated pregnancies.
Following delivery, cord blood obtained from the placental portion of the umbilical cord will be used for analysis.
To assure appropriate dilution, a hematocrit will be measured at the time of blood collection using a blood gas machine for prompt results.
Sample blood will immediately be taken by the investigators from the delivery hospital to the children's hospital where the following clotting studies will be performed: PT, aPTT, fibrinogen, platelet count, platelet mapping, and TEG6s.
Specimens will be transported utilizing Specimen Transport Guidelines.
|
Cord blood will be utilized to perform lab test including PT, aPTT, fibrinogen, platelet count, platelet mapping, and TEG6s
|
Term infants of diabetic mothers
Infants born at 37 weeks gestational age or greater to mothers of any age with gestational diabetes or Type 1 or Type 2 diabetes, managed with either diet or insulin.
Following delivery, cord blood obtained from the placental portion of the umbilical cord will be used for analysis.
To assure appropriate dilution, a hematocrit will be measured at the time of blood collection using a blood gas machine for prompt results.
Sample blood will immediately be taken by the investigators from the delivery hospital to the children's hospital where the following clotting studies will be performed: PT, aPTT, fibrinogen, platelet count, platelet mapping, and TEG6s.
Specimens will be transported utilizing Specimen Transport Guidelines.
|
Cord blood will be utilized to perform lab test including PT, aPTT, fibrinogen, platelet count, platelet mapping, and TEG6s
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Coagulation Index
Time Frame: Data will be obtained at time of delivery on day of life 1
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The coagulation index composed of the various components from TEG6s will be calculated and analyzed by a statistician
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Data will be obtained at time of delivery on day of life 1
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Collaborators and Investigators
Investigators
- Principal Investigator: Alexandra G Woodle, MD, ACHRI
Publications and helpful links
General Publications
- Edwards RM, Naik-Mathuria BJ, Gay AN, Olutoye OO, Teruya J. Parameters of thromboelastography in healthy newborns. Am J Clin Pathol. 2008 Jul;130(1):99-102. doi: 10.1309/LABNMY41RUD099J2.
- Sidlik R, Strauss T, Morag I, Shenkman B, Tamarin I, Lubetsky A, Livnat T, Kenet G. Assessment of Functional Fibrinolysis in Cord Blood Using Modified Thromboelastography. Pediatr Blood Cancer. 2016 May;63(5):839-43. doi: 10.1002/pbc.25865. Epub 2016 Jan 8.
- Sewell EK, Forman KR, Wong EC, Gallagher M, Luban NL, Massaro AN. Thromboelastography in term neonates: an alternative approach to evaluating coagulopathy. Arch Dis Child Fetal Neonatal Ed. 2017 Jan;102(1):F79-F84. doi: 10.1136/archdischild-2016-310545. Epub 2016 May 13.
- Erdoes G, Schloer H, Eberle B, Nagler M. Next generation viscoelasticity assays in cardiothoracic surgery: Feasibility of the TEG6s system. PLoS One. 2018 Dec 20;13(12):e0209360. doi: 10.1371/journal.pone.0209360. eCollection 2018.
- Lloyd-Donald P, Churilov L, Zia F, Bellomo R, Hart G, McCall P, Martensson J, Glassford N, Weinberg L. Assessment of agreement and interchangeability between the TEG5000 and TEG6S thromboelastography haemostasis analysers: a prospective validation study. BMC Anesthesiol. 2019 Mar 30;19(1):45. doi: 10.1186/s12871-019-0717-7.
- Sarkar S, Hagstrom NJ, Ingardia CJ, Lerer T, Herson VC. Prothrombotic risk factors in infants of diabetic mothers. J Perinatol. 2005 Feb;25(2):134-8. doi: 10.1038/sj.jp.7211222.
- Oppenheimer EH, Esterly JR. Thrombosis in the newborn: comparison between infants of diabetic and nondiabetic mothers. J Pediatr. 1965 Oct;67(4):549-56. doi: 10.1016/s0022-3476(65)80424-3. No abstract available.
Study record dates
Study Major Dates
Study Start (ANTICIPATED)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 262407
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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