Disseminated Intravascular Coagulation in Term and Preterm Neonates

Abstract

Among critically ill patients, the risk of developing disseminated intravascular coagulation (DIC) is probably highest in neonates. Low plasma reserves in pro- and anticoagulant coagulation factors, intravascular volume contraction after birth, and a high incidence of hypoxia and sepsis in critically ill newborns rapidly lead to a decompensation of the coagulation system in this population. Global coagulation tests and single-factor plasma levels have to be interpreted in the context of age-corrected normal ranges. Platelet consumption and reduced protein C plasma levels have diagnostic value; the latter also has prognostic potential in neonates with DIC and sepsis. Therapeutic success relies heavily on reversal of the underlying condition. Some coagulation-specific therapies have been explored in small studies and case series with varying success and sometimes conflicting results. Therefore, larger controlled trials in this common and serious condition are urgently needed.

Thrombocytopenia in the First 24 Hours After Birth and Incidence of Patent Ductus Arteriosus

“…We also did not find an association between platelet number in the first 24 hours after birth and PDA on DOL 4 to 5 in VLBW/ELBW preterm infants, regardless of whether the infants had subsequently received pharmacologic COX inhibition, secondary ligation, or no therapy (Fig 2). Moreover, when we used the exact same inclusion criteria as Echtler et al 13 (24)(25)(26)(27)(28)(29)(30) weeks' gestation), we still did not find any association between platelet number and PDA (n = 947; data not shown).…”

“…Interestingly, all the latter variables may affect platelet function. 23,24 Given the findings on platelettriggered ductal sealing in mice, 13 we speculate that platelet dysfunction (due to immaturity [25][26][27] or critical illness 23,24,28 ) rather than platelet number contributes to the pathogenesis of PDA. 22 Although the platelet numbers reported in our study were determined in the first 24 hours after birth, and before any indomethacin or ibuprofen administration, we cannot rule out that a platelet nadir occurred on DOL 2 to 5, which may have influenced the efficiency of COX inhibition or the need for secondary surgical ligation in infants with hemodynamically significant PDA, especially when other risk factors such as sepsis/inflammation were present.…”

Automated Quantification of Fragmented Red Blood Cells: Neonatal Reference Intervals and Clinical Disorders of Neonatal Intensive Care Unit Patients with High Values

“…In our study, 29% of CBCs with a very high FRC were from neonates who had DIC. Indeed schistocytosis is common in DIC, and following the FRC in neonates with DIC could be a useful marker for improvement or worsening [17,18].…”

Disseminated intravascular coagulation in paediatrics

“…Neonates are more vulnerable to DIC than older infants and children 5. Platelets and coagulation factors are first detectable at 56 and 10 weeks7 of gestation, respectively.…”

“…Platelets and coagulation factors are first detectable at 56 and 10 weeks7 of gestation, respectively. Platelets reach normal range of 150–450×109/L at 22 weeks of gestation6 and most coagulation factors achieve adult values by 6 months of postnatal age, with a few notable exceptions 5. Platelets are found to be hyporeactive and aggregation is impaired due to deficiency of α-adrenergic receptors on platelet membrane, especially in preterm infants <30 weeks of gestation, but this dysfunction is balanced by elevated von Willebrand factor levels 5 6.…”