Protein C, protein S and C4b-binding protein in neonatal severe infection and septic shock

Abstract

We have studied the behaviour of total protein S, free protein S, protein C and C4b-binding protein fifteen neonates with severe infections, eight with septic shock and in a group of ten healthy newborns. Protein C was decreased in shock and septic patients, but only the shock group showed significant differences compared to normal neonates. Total protein S was normal in both groups of patients, although free protein S had significantly lower values in shock and nonshock infants. C4b-binding protein was higher than normal in septic and shock patients compared to the control group. Decreased values of protein C and free protein S can be explained by the activation of coagulation and their subsequent consumption. On the other hand, the increased levels of C4b-binding protein can affect the distribution of protein S in plasma, producing a shift in protein S to the complexed inactive form. These findings can contribute to an increased risk of microthrombosis during neonatal sepsis.

Successful Management of Neonatal Myocardial Infarction with ECMO and Intracoronary r-tPA lysis

“…The newborn typically has reduced level of inhibitors of coagulation including Protein C and Protein S. Acquired coagulation factor deficiency may also occur with severe infection and shock . Beyond, genetic aberrations in the plasminogen activator inhibitor‐1 (PAI‐1) and in the methylenetetrahydrofolate reductase (MTHFR) genes have been associated with spontaneous thromboembolism, both of which we, however, did not specifically screen in our patient. Septic standard thrombophilic assays were unremarkable.…”

Neonatal Sepsis: A Challenge in Hemostaseology

“…89 During sepsis, however, this hypercoagulability is further exacerbated by decreasing inhibiting coagulation factors such as antithrombin (AT), PC, and protein S combined with the already mentioned inhibition of fibrinolysis by PAI-1, a phenomenon also observed in neonates. 10 Obstructed dermal microcirculation with consecu tive skin necrosis known as purpura fulminans (PF) is a common finding in meningococcal sepsis. In newborn and preterm infants, the development of PF is also ob served in Enterobacter-and Staphylococcus-induced sepsis, reflecting the augmented risk of microcirculatory thrombosis in these patients.…”

Acute myocardial infarction in the neonatal period

“…2 The normal newborn has a reduced level of inhibitors of coagulation including Protein C and Protein S. Acquired deficiency of these proteins may occur with severe infection and shock. 9 Perinatal asphyxia is one of the commonest cause of acute myocardial dysfunction. There is not enough evidence to suggest a correlation between the severity of perinatal asphyxia and the degree of myocardial damage.…”