Disseminated Intravascular Coagulation in the Neonatal Period

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Definition, Etiology, and Relevance

Disseminated intravascular coagulation is a bleeding disorder characterized by two seemingly opposite conditions. As a caregiver in a neonatal intensive care unit (NICU), it is not uncommon to think first of uncontrolled bleeding at the mention of DIC. This is not incorrect, merely incomplete. DIC is a condition of uncontrolled bleeding, simultaneous with uncontrolled clotting, set into motion by an inappropriate activation and consumption of clotting factors resulting in a hemorrhagic state due to inadequate hemostasis.^[5]

DIC is not a primary diagnosis, but instead a secondary coagulation disorder that complicates various primary conditions.^[2,3,6] The range of presentation varies widely with the underlying status of the infant and the severity of the triggering event.^[1,4] Some of the most common underlying pathologies are asphyxia, sepsis, and respiratory distress syndrome (RDS). It is postulated that the acid-base imbalances and shock that often accompanies these common neonatal problems cause a release of endotoxins and endothelial damage. These in turn stimulate the pathways of coagulation and fibrinolysis.^[2]

The true incidence of DIC in the newborn is not easily defined by the literature, because DIC may remain undetected until the neonate presents with severe hemorrhaging or the disease is determined at autopsy.^[2,4,6] Despite evidence that newborns are in a hypercoagulable state,^[2,7,8] there does not seem to be clear or universally accepted criteria to diagnose DIC in the neonatal ICU. The most frequent causes of DIC, cardiovascular compromise and infection, are very prevalent in this population. Shock and asphyxia, though not as prevalent, are also seen in these fragile patients and initiate the pathway leading to DIC. The disease has been referred to as a "common occurrence" due to the increased susceptibility of these patients as a result of prematurity of antithrombotic functions, an immature reticuloendothelial system, and a tendency to develop acidosis, hypothermia, hypoxia, and shock. While earlier literature states that DIC seems to be frequent in sick neonates, more recent articles discuss the decrease in incidence based on better proactive management and optimal intensive care.^[810] Regardless of these measures, of all the DIC reported in children, half occurs during the neonatal period.^[1]

Cite this: Disseminated Intravascular Coagulation in the Neonatal Period - Medscape - Dec 01, 2004.

Table 1. Mean Coagulation Values in Fetuses and Full-Term Infants
Parameter	2429 Week Fetus	3038 Week Fetus	Term Newborn
PT	32.2	22.6	16.7
APTT	154.0	108.4	44.3

PT, prothrombin time; APTT, activated partial thromboplastin time.
Adapted from Reverdiau-Moalic et al.^[19]

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