Study of protein C, protein S, and antithrombin III in hypoxic newborns*

Abstract

In this study, we evaluated the effect of asphyxia on the physiologic inhibition system of coagulation in neonates. Care providers should suspect hypoxia resulting from any obstructed labor and perform the necessary laboratory investigations for coagulation, including antithrombin III, protein C, and protein S levels, to help prevent thromboembolic accidents in asphyxiated neonates, including disseminated intravascular coagulation, necrotizing enterocolitis, and intracranial hemorrhage. Based on the development of antithrombin III and protein C concentrates, which are commercially available, require minimal monitoring, and have very few side effects, the time is ripe for evaluation of optimal treatment for thromboembolic accidents after neonatal asphyxia. This could be even more important if successful neuroprotectant strategies are also developed.

Risk factors for perinatal arterial ischaemic stroke in full-term infants: a case-control study

“…Hypoxia-ischaemia might play a role in activation of thrombogenesis, as it decreases physiologically inhibiting anticoagulants, including antithrombin III, proteins C and S resulting in hypercoagulability 21 22. Adhami et al 23 found that ischaemia-hypoxia is a rapid and powerful stimulus for spontaneous coagulation in mice that underwent the Levine/Vannucci procedure, mimicking perinatal hypoxic-ischaemic brain injury 24.…”

A baby with low Apgar scores at birth: Table 1

“…It may be useful to measure levels of antithrombin III, protein C, and protein S-components of the physiological inhibition pathway of coagulation-because these are decreased in HIE. 26 Other possible findings include raised urea and creatinine and deranged electrolytes owing to acute renal failure; raised alanine aminotransferase, raised aspartate aminotransferase, and deranged clotting owing to liver dysfunction. Blood gases often show a hypoxic picture, with raised lactate and metabolic acidosis.…”

Antibiotic prophylaxis in cesarean section causing anaphylaxis and intrauterine fetal death

“…8 Intrauterine fetal hypoxia also triggered coagulation disturbances in asphyxiated neonates. 9 Thus, the challenge is not only to stabilize the mother as early as possible but also expediate the delivery of the hypoxic and distressed fetus. 10 The situation may become more difficult if the platelet count in the mother starts falling below a critical limit initiating DIVC, a serious condition.…”