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Diagnosis of Neonatal Diseases

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 20655

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Prof. Dr. Zbynek Stranak

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Department of Neonatology, Institute for the Care of Mother and Child, Podolske Nabrezí 157/36, 14700 Prague 4, Czech Republic
Interests: neonatal infection; respiratory failure in newborn; congenital diaphragmatic hernia

Special Issue Information

Dear Colleagues,

Advances in neonatal intensive care have led to improved survival in critically ill infants and extremely tiny babies. Newly branded technologies, surgical techniques, and therapeutics have dramatically changed the management, timing of treatment, and outcomes of common neonatal diseases and life-threatening events. Early, fast, and accurate diagnosis of serious neonatal complications remains crucial in the management and treatment of diseases like respiratory distress syndrome, neonatal sepsis, intracranial hemorrhage, hypoxic ischemic encephalopathy, patent ductus arteriosus, and necrotizing enterocolitis.

The aim of this Special Issue entitled “Diagnosis of Neonatal Diseases” is to provide state-of- the-art information on the current diagnostics methods used in neonatal intensive care. Moreover, new advances in neonatal screening based on comprehensive genetic evaluation are addressed to healthy newborns.

We invite researchers and authors to submit original works concerning their important findings. Highly valuable review articles on this topic are also encouraged. This Special Issue will be dedicated to our newborn patients and their families, who make us strive to improve our knowledge and expertise so that we can provide the best possible care.

Prof. Dr. Zbynek Stranak
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (12 papers)

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Research

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11 pages, 1524 KiB

Open AccessArticle

The Prevalence of Multidrug-Resistant Enterobacteriaceae among Neonates in Kuwait

by Rehab Zafer Alajmi, Wadha Ahmed Alfouzan and Abu Salim Mustafa

Diagnostics 2023, 13(8), 1505; https://doi.org/10.3390/diagnostics13081505 - 21 Apr 2023

Cited by 1 | Viewed by 1450

Abstract

Increasing numbers of neonates with serious bacterial infections, due to resistant bacteria, are associated with considerable morbidity and mortality rates. The aim of this study was to evaluate the prevalence of drug-resistant Enterobacteriaceae in the neonatal population and their mothers in Farwaniya Hospital in Kuwait and to determine the basis of resistance. Rectal screening swabs were taken from 242 mothers and 242 neonates in labor rooms and wards. Identification and sensitivity testing were performed using the VITEK^® 2 system. Each isolate flagged with any resistance was subjected to the E-test susceptibility method. The detection of resistance genes was performed by PCR, and the Sanger sequencing method was used to identify mutations. Among 168 samples tested by the E-test method, no MDR Enterobacteriaceae were detected among the neonates, while 12 (13.6%) isolates from the mothers’ samples were MDR. ESBL, aminoglycosides, fluoroquinolones, and folate pathway inhibitor resistance genes were detected, while beta-lactam–beta-lactamase inhibitor combinations, carbapenems, and tigecycline resistance genes were not. Our results showed that the prevalence of antibiotic resistance in Enterobacteriaceae obtained from neonates in Kuwait is low, and this is encouraging. Furthermore, it is possible to conclude that neonates are acquiring resistance mostly from the environment and after birth but not from their mothers. Full article

(This article belongs to the Special Issue Diagnosis of Neonatal Diseases)

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10 pages, 280 KiB

Open AccessArticle

PAH Pathogenic Variants and Clinical Correlations in a Group of Hyperphenylalaninemia Patients from North-Western Romania

by Alin Iuhas, Claudia Jurca, Kinga Kozma, Anca-Lelia Riza, Ioana Streață, Codruța Petcheși, Andra Dan, Cristian Sava, Andreea Balmoș, Cristian Marinău, Larisa Niulaș, Mihai Ioana and Marius Bembea

Diagnostics 2023, 13(8), 1483; https://doi.org/10.3390/diagnostics13081483 - 20 Apr 2023

Cited by 2 | Viewed by 1016

Abstract

Phenylketonuria (PKU) is caused by mutations in the phenylalanine hydroxylase (PAH) gene and is characterized by altered amino acid metabolism. More than 1500 known PAH variants intricately determine a spectrum of metabolic phenotypes. We aim to report on clinical presentation and PAH variants identified in 23 hyperphenylalaninemia (HPA)/PKU Romanian patients. Our cohort exhibited classic PKU (73.9%, 17/23), mild PKU (17.4%, 4/23), and mild HPA (8.7%, 2/23). Severe central nervous system sequelae are frequent in our cohort in late-diagnosis symptomatic patients, which highlights yet again the significance of an early dietary treatment, neonatal screening and diagnosis, and facilitated access to treatment. Next-generation sequencing (NGS) identified a total of 11 PAH pathogenic variants, all previously reported, mostly missense changes (7/11) in important catalytic domains. c.1222C>T p.Arg408Trp was the most frequent variant, with an allele frequency of 56.5%. Twelve distinct genotypes were identified, the most frequent of which was p.Arg408Trp/p.Arg408Trp (34.8%, 8/23). Compound heterozygous genotypes were common (13/23), three of which had not been previously reported to the best of our knowledge; two correlated with cPKU and one showed an mPKU phenotype. Generally, there are genotype–phenotype correlation overlaps with the public data reported in BIOPKUdb; as our study shows, clinical correlates are subject to variation, in part due to uncontrolled or unknown epigenetic or environmental regulatory factors. We highlight the importance of establishing the genotype on top of using blood phenylalanine levels. Full article

(This article belongs to the Special Issue Diagnosis of Neonatal Diseases)

24 pages, 4423 KiB

Open AccessArticle

Using CCA-Fused Cepstral Features in a Deep Learning-Based Cry Diagnostic System for Detecting an Ensemble of Pathologies in Newborns

by Zahra Khalilzad and Chakib Tadj

Diagnostics 2023, 13(5), 879; https://doi.org/10.3390/diagnostics13050879 - 24 Feb 2023

Cited by 3 | Viewed by 1308

Abstract

Crying is one of the means of communication for a newborn. Newborn cry signals convey precious information about the newborn’s health condition and their emotions. In this study, cry signals of healthy and pathologic newborns were analyzed for the purpose of developing an automatic, non-invasive, and comprehensive Newborn Cry Diagnostic System (NCDS) that identifies pathologic newborns from healthy infants. For this purpose, Mel-frequency Cepstral Coefficients (MFCC) and Gammatone Frequency Cepstral Coefficients (GFCC) were extracted as features. These feature sets were also combined and fused through Canonical Correlation Analysis (CCA), which provides a novel manipulation of the features that have not yet been explored in the literature on NCDS designs, to the best of our knowledge. All the mentioned feature sets were fed to the Support Vector Machine (SVM) and Long Short-term Memory (LSTM). Furthermore, two Hyperparameter optimization methods, Bayesian and grid search, were examined to enhance the system’s performance. The performance of our proposed NCDS was evaluated with two different datasets of inspiratory and expiratory cries. The CCA fusion feature set using the LSTM classifier accomplished the best F-score in the study, with 99.86% for the inspiratory cry dataset. The best F-score regarding the expiratory cry dataset, 99.44%, belonged to the GFCC feature set employing the LSTM classifier. These experiments suggest the high potential and value of using the newborn cry signals in the detection of pathologies. The framework proposed in this study can be implemented as an early diagnostic tool for clinical studies and help in the identification of pathologic newborns. Full article

(This article belongs to the Special Issue Diagnosis of Neonatal Diseases)

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16 pages, 1461 KiB

Open AccessArticle

Cystic Fibrosis: A Descriptive Analysis of Deaths in a Two-Decade Period in Brazil According to Age, Race, and Sex

by Luan Victor Frota de Azevedo, Fernanda Cristine Ribeiro Medeiros Cruz, Jéssica Paula Martins and Fernando Augusto Lima Marson

Diagnostics 2023, 13(4), 763; https://doi.org/10.3390/diagnostics13040763 - 17 Feb 2023

Cited by 4 | Viewed by 2280

Abstract

The diagnosis of cystic fibrosis has improved in the last few years due to greater access to diagnostic tools and the evolution of molecular biology; the knowledge obtained has contributed to the understanding of its death profile. In this context, an epidemiological study was developed focusing on deaths from cystic fibrosis in Brazil from 1996 to 2019. The data were collected from the Data-SUS (Unified National Health System Information Technology Department from Brazil). The epidemiological analysis included patients’ age groups, racial groups, and sex. In our data, between 1996 and 2019, Σ3050 deaths were recorded, totaling a ≅330% increase in the number of deaths resulting from cystic fibrosis. This fact might be related to a better diagnosis of the disease, mainly in patients from racial groups that are not commonly associated with cystic fibrosis, such as Black individuals, Hispanic or Latino (mixed individuals/Pardos) individuals, and American Indians (Indigenous peoples from Brazil). Regarding of race, the Σ of deaths was: nine (0.3%) in the American Indian group, 12 (0.4%) in the Asian group, 99 (3.6%) in the Black or African American group, 787 (28.6%) in the Hispanic or Latino group, and 1843 (67.0%) in the White group. The White group showed the highest prevalence of deaths, and the increase in mortality was ≅150 times in this group, while, in the Hispanic or Latino group, it was ≅75 times. Regarding sex, the numbers and percentage of deaths of both male (N = 1492; 48.9%) and female (N = 1557; 51.1%) patients were seen to be relatively close. As for age groups, the >60-year-old group presented the most significant results, with an increase of ≅60 times in the registered deaths. In conclusion, in Brazil, despite the number of deaths from cystic fibrosis being prevalent in the White group, it increased in all racial groups (Hispanic or Latino, Black or African American, American Indian, or Asian individuals) and was associated with older age. Full article

(This article belongs to the Special Issue Diagnosis of Neonatal Diseases)

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8 pages, 625 KiB

Open AccessArticle

Changing Laboratory Practice for Early Detection of a Fetal Inflammatory Response: A Contemporary Approach

by Yin Ping Wong and T Yee Khong

Diagnostics 2023, 13(3), 487; https://doi.org/10.3390/diagnostics13030487 - 29 Jan 2023

Cited by 2 | Viewed by 1145

Abstract

Neonates born with the fetal inflammatory response (FIR) are at risk of complications such as early-onset neonatal sepsis, meningitis, and pneumonia. Providing an early histopathological diagnosis of FIR is important to guide management but can be a challenge in busy laboratories. This is a retrospective cross-sectional study over a four-month duration recruiting all placental cases with histological chorioamnionitis in our institution. The diagnostic performance of the umbilical cord (UC) section in identifying FIR, relative to the corresponding subsequent placental sections, was assessed. Clinical predictors of umbilical cord FIR were also investigated. A total of 390 UC sections were analyzed, of which 206 (52.8%) were found positive for FIR: 111 cases (53.9%) stage 1, 87 (42.2%) stage 2, and 8 (3.9%) stage 3. Our data revealed a good diagnostic sensitivity, specificity, positive predictive value, and accuracy of 76.2% (95%CI: 68.6–82.7%), 82.4% (95%CI: 65.5–93.2%), 95.0% (95%CI: 90.2–97.6%), and 77.3% (95%CI: 70.6–83.1%) respectively, in cases when clinical chorioamnionitis, fever and/or prolonged rupture of membrane (PROM) were suspected, with the area under the curve of 0.793. A maternal inflammatory response (MIR) was correlated with FIR (p < 0.001). Multivariate logistic regression analysis indicated that the higher the gestational age, clinical suspicion of chorioamnionitis, fever, and/or PROM, and the higher the stage of MIR significantly increased the odds of FIR (p < 0.001). UC section diagnosis of FIR is reasonably accurate in cases with clinical chorioamnionitis, fever, and/or PROM. Changing current laboratory practice to rapid processing of UC ahead of the rest of the other placental sections can be recommended in busy pathology departments. Full article

(This article belongs to the Special Issue Diagnosis of Neonatal Diseases)

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10 pages, 986 KiB

Open AccessArticle

Distribution of Presepsin, Krebs von den Lungen 6, and Surfactant Protein A in Umbilical Cord Blood

by Minjeong Nam, Mina Hur, Hanah Kim, Gun-Hyuk Lee, Mikyoung Park, Han-Sung Kwon, Han-Sung Hwang and In-Sook Sohn

Diagnostics 2022, 12(9), 2213; https://doi.org/10.3390/diagnostics12092213 - 13 Sep 2022

Cited by 2 | Viewed by 1203

Abstract

Presepsin is an early indicator of infection, and Krebs von den Lungen 6 (KL-6) and Surfactant Protein A (SP-A) are related to the pathogenesis of pulmonary infection and fibrosis. This study aimed to establish reference intervals (RIs) of presepsin, KL-6, and SP-A levels and to evaluate the possible influence of neonatal and maternal factors on presepsin, KL-6, and SP-A levels in umbilical cord blood (UCB). Among a total of 613 UCB samples, the outliers were removed. The RIs for presepsin, KL-6, and SP-A levels were defined using non-parametric percentile methods according to the Clinical and Laboratory Standards Institute guidelines (EP28-A3C). These levels were analyzed according to neonatal and maternal factors: neonatal sex, gestational age (GA), birth weight (BW), Apgar score, delivery mode, the presence of premature rupture of membranes (PROM), gestational diabetes mellitus (GDM), and pre-eclampsia. Presepsin, KL-6, and SP-A levels showed non-parametric distributions and left-skewed histograms. The RIs of presepsin, KL-6, and SP-A levels were 64.9–428.3 pg/mL, 43.0–172.0 U/mL, and 2.1–36.1 ng/mL, respectively. Presepsin, KL-6, and SP-A levels did not show significant differences according to sex, GA, BW, Apgar score, delivery mode, PROM, GDM, and pre-eclampsia. The median level and 97.5th centile RI of KL-6 showed a slight increase with increased GA. We established RIs for presepsin, KL-6, and SP-A levels in large-scaled UCB samples. Further investigation would be needed to determine the clinical significance. Full article

(This article belongs to the Special Issue Diagnosis of Neonatal Diseases)

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11 pages, 571 KiB

Open AccessArticle

Gestational Diabetes Melitus and Cord Blood Platelet Function Studied via the PFA-100 System

by Vasiliki Mougiou, Theodora Boutsikou, Rozeta Sokou, Maria Kollia, Serena Valsami, Abraham Pouliakis, Maria Boutsikou, Marianna Politou, Nicoletta Iacovidou and Zoe Iliodromiti

Diagnostics 2022, 12(7), 1645; https://doi.org/10.3390/diagnostics12071645 - 06 Jul 2022

Cited by 1 | Viewed by 1715

Abstract

Neonatal platelet hemostasis, although it has been well described over the recent years, remains elusive in specific patient populations, including neonates from high-risk pregnancies, such as those complicated with gestational diabetes mellitus (GDM). We aimed at evaluating the platelet function of neonates born to mothers with GDM using the platelet function analyzer (PFA-100). Cord blood samples were drawn from each subject and tested with two different agonists to provide two closure time (CT) values (collagen with epinephrine (COL/EPI) and collagen with adenosine diphosphate (COL/ADP)). A total of 84 and 118 neonates formed the GDM and the control group (neonates from uncomplicated pregnancies), respectively. COL/EPI CTs were prolonged in neonates from the GDM group compared to neonates from the control group, while no statistically significant difference of COL/ADP CTs was noted between the two groups, GDM and the control. Higher COL/ADP CTs were demonstrated in neonates born via cesarean section and in neonates with blood group O. A negative correlation between COL/ADP CT and gestational age, white blood cells (WBCs) and von Willebrand factor (VWF) activity was noted in neonates from the GDM group. In conclusion, neonates from the GDM group demonstrate a more hyporesponsive phenotype of their platelets, in comparison to the control neonates. Full article

(This article belongs to the Special Issue Diagnosis of Neonatal Diseases)

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11 pages, 998 KiB

Open AccessArticle

Reduced Cerebellar Volume in Term Infants with Complex Congenital Heart Disease: Correlation with Postnatal Growth Measurements

by Rafael Ceschin, Alexandria Zahner, William Reynolds, Nancy Beluk and Ashok Panigrahy

Diagnostics 2022, 12(7), 1644; https://doi.org/10.3390/diagnostics12071644 - 06 Jul 2022

Cited by 1 | Viewed by 1210

Abstract

Aberrant cerebellar development and the associated neurocognitive deficits has been postulated in infants with congenital heart disease (CHD). Our objective is to investigate the effect of postnatal head and somatic growth on cerebellar development in neonates with CHD. We compared term-born neonates with a history of CHD with a cohort of preterm-born neonates, two cohorts at similar risk for neurodevelopment impairment, in order to determine if they are similarly affected in the early developmental period. Study Design: 51 preterms-born healthy neonates, 62 term-born CHD neonates, and 54 term-born healthy neonates underwent a brain MRI with volumetric imaging. Cerebellar volumes were extracted through an automated segmentation pipeline that was developed in-house. Volumes were correlated with clinical growth parameters at both the birth and time of MRI. Results: The CHD cohort showed significantly lower cerebellar volumes when compared with both the control (p < 0.015) and preterm (p < 0.004) groups. Change in weight from birth to time of MRI showed a moderately strong correlation with cerebellar volume at time of MRI (r = 0.437, p < 0.002) in the preterms, but not in the CHD neonates (r = 0.205, p < 0.116). Changes in birth length and head circumference showed no significant correlation with cerebellar volume at time of MRI in either cohort. Conclusions: Cerebellar development in premature-born infants is associated with change in birth weight in the early post-natal period. This association is not observed in term-born neonates with CHD, suggesting differential mechanisms of aberrant cerebellar development in these perinatal at-risk populations. Full article

(This article belongs to the Special Issue Diagnosis of Neonatal Diseases)

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11 pages, 794 KiB

Open AccessArticle

Neonatal Sequential Organ Failure Assessment (nSOFA) Score within 72 Hours after Birth Reliably Predicts Mortality and Serious Morbidity in Very Preterm Infants

by Ivan Berka, Peter Korček, Jan Janota and Zbyněk Straňák

Diagnostics 2022, 12(6), 1342; https://doi.org/10.3390/diagnostics12061342 - 28 May 2022

Cited by 5 | Viewed by 2463

Abstract

The aim of this study was to assess the applicability of the neonatal sequential organ failure assessment score (nSOFA) within 72 h after delivery as a predictor for mortality and adverse outcome in very preterm neonates. Inborn neonates <32 weeks of gestation were evaluated. The nSOFA scores were calculated from medical records in the first 72 h after birth and the peak value was used for analysis. Death or composite morbidity at hospital discharge defined the adverse outcome. Composite morbidity consisted of chronic lung disease, intraventricular haemorrhage ≥grade III, periventricular leukomalacia and necrotizing enterocolitis. Among 423 enrolled infants (median birth weight 1070 g, median gestational age 29 weeks), 27 died and 91 developed composite morbidity. Death or composite morbidity was associated with organ dysfunction as assessed by nSOFA, systemic inflammatory response, and low birthweight. The score >2 was associated with OR 2.5 (CI 1.39–4.64, p = 0.002) for the adverse outcome. Area under the curve of ROC was 0.795 (95% CI = 0.763–0.827). The use of nSOFA seems to be reasonable for predicting mortality and morbidity in very preterm infants. It constitutes a suitable basis to measure the severity of organ dysfunction regardless of the cause. Full article

(This article belongs to the Special Issue Diagnosis of Neonatal Diseases)

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Review

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10 pages, 815 KiB

Open AccessReview

Trends in Neonatal Ophthalmic Screening Methods

by Martin Hložánek, Zbyněk Straňák, Zuzana Terešková, Jan Mareš, Inka Krejčířová and Marie Česká Burdová

Diagnostics 2022, 12(5), 1251; https://doi.org/10.3390/diagnostics12051251 - 18 May 2022

Cited by 2 | Viewed by 2020

Abstract

Neonatal ophthalmic screening should lead to early diagnosis of ocular abnormalities to reduce long-term visual impairment in selected diseases. If a treatable pathology is diagnosed within a few days after the birth, adequate therapy may be indicated to facilitate the best possible conditions for further development of visual functions. Traditional neonatal ophthalmic screening uses the red reflex test (RRT). It tests the transmittance of the light through optical media towards the retina and the general disposition of the central part of the retina. However, RRT has weaknesses, especially in posterior segment affections. Wide-field digital imaging techniques have shown promising results in detecting anterior and posterior segment pathologies. Particular attention should be paid to telemedicine and artificial intelligence. These methods can improve the specificity and sensitivity of neonatal eye screening. Both are already highly advanced in diagnosing and monitoring of retinopathy of prematurity. Full article

(This article belongs to the Special Issue Diagnosis of Neonatal Diseases)

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Other

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10 pages, 459 KiB

Open AccessCase Report

First Neonates with Vertical Transmission of SARS-CoV-2 Infection in Late Pregnancy in West Part of Romania: Case Series

by Daniela Iacob, Ileana Enatescu, Mirabela Dima, Elena Bernad, Manuela Pantea, Daiana Bozgan, Sandor Bernad and Marius Craina

Diagnostics 2022, 12(7), 1668; https://doi.org/10.3390/diagnostics12071668 - 09 Jul 2022

Cited by 3 | Viewed by 1331

Abstract

The Coronavirus disease 2019 (COVID-19) pandemic has exposed the vulnerable neonatal population to unknown risks. Given that herd immunity is has not been reached, the entire population is susceptible to Severe Acute Respiratory Syndrome Coronavirus 2 Virus(SARS-CoV-2) infection. The arising concern about the vertical transmission of neonatal complications caused by the novel coronavirus is a continuous challenge for managing newborns, considering the rare cases and unclear guidelines. Therefore, a retrospective study was conducted in a tertiary unit from Timisoara, Romania. Of the 283 newborns born during the study period, only 3 neonates were diagnosed with SARS-CoV-2 infection in the first 24 h of life (DOL-0). The present study plans to identify the findings, including clinical features, laboratory characteristics, and outcomes of newborns with vertical transmission of SARS-CoV-2. All infected neonates were confirmed with COVID-19 by Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) from nasal aspirates and were isolated in the neonatology department. They were the first and the only neonate infected at birth from the West part of Romania. The clinical findings were unremarkable except for one neonate who developed mild respiratory distress syndrome. Elevated IgG-specific anti-SARS-CoV-2 serum levels were found in one newborn. Swab samples in DOL-0 strengthened the awareness of vertical transmission, although peripartum SARS-CoV-2 infection does not seem responsible for severe symptoms. We conclude that vertical transmission is rare in late pregnancy. Even if the studied newborns showed mild forms of COVID-19, it is essential to note that newborns represent a particular category of patients. More studies are needed to complete the observations of this study. Full article

(This article belongs to the Special Issue Diagnosis of Neonatal Diseases)

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15 pages, 647 KiB

Open AccessSystematic Review

The Non-Activated Thromboelastometry (NATEM) Assay’s Application among Adults and Neonatal/Pediatric Population: A Systematic Review

by Petroula Georgiadou, Rozeta Sokou, Andreas G. Tsantes, Stavroula Parastatidou, Aikaterini Konstantinidi, Dimitra Houhoula, Styliani Kokoris, Nicoletta Iacovidou and Argirios E. Tsantes

Diagnostics 2022, 12(3), 658; https://doi.org/10.3390/diagnostics12030658 - 08 Mar 2022

Cited by 11 | Viewed by 2304

Abstract

The non-activated thromboelastometry (NATEM) assay is a point-of-care assay that can provide a comprehensive insight into the actual hemostatic mechanism. However, there are very limited data about its use in clinical practice. The aim of this study was to systematically review the literature for any data regarding the use of NATEM in several clinical settings. A systematic review of PubMed and Scopus databases was conducted through 20 January 2022 for studies evaluating the use of the NATEM assay in different clinical settings. The literature search yielded a total of 47 publications, 30 of which met the eligibility criteria for this review. Evaluation of NATEM’s detecting ability for hemostasis disorders is limited in the literature. The results of the included studies indicate that NATEM seems to be a sensitive method for the detection of hyperfibrinolysis and may have an advantage in the diagnosis of hemostatic disorders. It could be more informative than the other ROTEM assays for detecting changes in coagulation parameters in patients who receive anticoagulants. However, the reported outcomes are highly varying among the included studies. NATEM has a high sensitivity to detect hypo- or hypercoagulability and provides a detailed insight into the whole hemostatic process from clot formation to clot breakdown. It could be a useful technique in variable fields of medicine, not only in adults, but also in pediatric and neonatal populations, to guide different hemostatic treatments and predict coagulation disorders or mortality/morbidity; this issue remains to be further investigated. Full article

(This article belongs to the Special Issue Diagnosis of Neonatal Diseases)

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