The effect of inhaled nitric oxide therapy on thromboelastogram in newborns with persistent pulmonary hypertension

Studies about the effects of inhaled nitric oxide (iNO) on bleeding time and platelet aggregation in newborns are limited in number and have inconclusive results. Thromboelastogram (TEG) shows the combined effects of coagulation factors and platelet functions. In this preliminary study, we aimed to evaluate the effects of iNO on coagulation using TEG in newborns with persistent pulmonary hypertension (PPH). TEG assays were performed in 10 term infants receiving iNO treatment for PPH and 32 healthy term infants. Samples of the iNO group were collected before and during iNO. Clot reaction time (R), clot kinetics (K), maximum amplitude (MA), and alpha angle were obtained from the TEG tracing. TEG-R values were statistically higher during iNO treatment (7.75?±?3.34) when compared to the values before iNO (4.83?±?1.38) and the healthy controls (3.75?±?0.98). The alpha angle was lower in iNO treated infants at both periods (before iNO, 55.33?±?8.58; during iNO, 42.90?±?18.34) compared to the control group (64.95?±?6.88). MA values before iNO treatment were the lowest (44.43?±?14.09) and improved with the iNO treatment (48.40?±?9.49) despite still being lower compared to the controls (53.67?±?5.56). Conclusion: Both PPH and iNO may negatively effect in vitro coagulation tests. Therefore, newborns with PPH requiring iNO treatment should be closely monitored for coagulation problems.