Disseminated intravascular coagulation in neonates
Disseminated intravascular coagulation (DIC) is one of the causes of high mortality in severe neonatal diseases. The trigger mechanisms of neonatal DIC syndrome are known to be:1
Severe hypoxia
Shock
Surgical intervention
Trauma
Sepsis
This is further reinforced by the definition given by the International Society of Thrombosis and Haemostasis (ISTH) to DIC, which states:2
“Disseminated intravascular coagulation is a syndrome characterized by the systemic activation of blood coagulation, which generates intravascular fibrin, leading to thrombosis of small and medium-sized vessels, and eventually organ dysfunction.”2
Furthermore, DIC rarely occurs without an underlying illness. However, in children, homozygous Protein C (PC) deficiency can lead to severe neonatal Purpura Fulminans (PF) due to low PC levels, without an underlying illness. Heterozygosity and homozygosity for PC deficiency, therefore, can also be considered a risk factor for DIC.3
The haemostatic system in neonates significantly differs from children and adults and leaves them vulnerable to DIC compared to the latter.4 Given the significant differences in the value of coagulation factors between children and adults, it is important to understand the development of haemostasis and interpret the results with caution.4
References:
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Ivanov D, et al. The specific characteristics of DIC syndrome vary with different clinical settings in the newborn. J Matern Fetal Neonatal Med. 2014;27:1088-1092.
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Wada H, et al. Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines. J Thromb Haemost. 2013;11:761-767.
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Sommeijer DW, Reitsma PH. Genetic Risk Factors for Disseminated Intravascular Coagulation. Madame Curie Bioscience Database [Internet]. Austin, TX: Landes Bioscience; 2000-2013.
https://www.ncbi.nlm.nih.gov/books/NBK6069/ [Last accessed May 2018]. -
Rajagopal R, et al. Disseminated intravascular coagulation in paediatrics. Arch Dis Child. 2017;102(2):187-193.
