Risk factors and treatments for disseminated intravascular coagulation in neonates

Abstract

Background Although disseminated intravascular coagulation (DIC) is a critical disease, there is few gold standard interventions in neonatal medicine. The aim of this study is to reveal factors affecting neonatal DIC at birth and to assess the effectiveness of rTM and FFP for DIC in neonates at birth. Methods We retrospectively evaluated DIC score on the first day of life in neonates with underlying conditions associated with DIC. DIC in neonates was diagnosed according to Japan Society of Obstetrical, Gynecological & Neonatal Hematology 2016 neonatal DIC criteria. Results Comparing neonates with DIC scores of ≥3 (n = 103) to those < 3 (n = 263), SGA, birth asphyxia, low Apgar score, hemangioma, hydrops, PIH, and PA were statistically increased. Among 55 neonates underwent DIC treatment, 53 had birth asphyxia and 12 had intraventricular hemorrhage. Forty-one neonates received FFP or a combination of FFP and antithrombin (FFP group), while 14 neonates received rTM or a combination of rTM, FFP, and antithrombin (rTM group). DIC score before treatment in the rTM group was significantly higher than in the FFP group (4.7 vs 3.6, P < 0.05). After treatment, DIC scores in both groups were significantly reduced on Day 1 and Day 2 (P < 0.05). Conclusions Among various factors associated with DIC in neonates at birth, birth asphyxia is particularly significant. Furthermore, rTM in combination with FFP therapy was effective for neonatal DIC at birth.

Diagnostic Scores and Treatment Options for Acute Disseminated Intravascular Coagulation in Children

“…Furthermore, DIC scores before treatment in Group 2 were higher than in Group 1 (4.7 vs 3.6, P < 0.05). Hence, they concluded that rTM and FFP were effective therapies for neonatal DIC [44].…”

Changes in the Use of Fresh-Frozen Plasma Transfusions in Preterm Neonates: A Single Center Experience

“…A small randomized trial by Gross et al previously showed that treatment with FFP yielded no difference in the outcome of DIC [18]. However, a recent study by Go et al showed that FFP in combination with recombinant human soluble thrombomodulin could be beneficial for the treatment of neonatal DIC [33].…”

Disseminated Intravascular Coagulation in Varying Age Groups Based on Clinical Conditions

“…The most crucial diagnostic tests to make a correct neonatal DIC diagnosis are the platelet count, D-dimer or FDP, PT, PTT, and fibrinogen [ 13 ]. The DIC diagnostic criteria of the Japan Society of Obstetrical, Gynecological & Neonatal Hematology, JSOGN, covers PLT, PT-INR, fibrinogen and d-dimer [ 14 ]. Neonates are given a score based on these factors ranging from 0 to 8.…”