Risk factors and treatments for disseminated intravascular coagulation in neonates

Hayato Go,Mina Chishiki,Hitoshi Ohto,Nozomi Kashiwabara,Kenneth E Nollet,Mitsuaki Hosoya,Kei Ogasawara,Shun Hiruta,Ichiri Sakuma,Yukihiko Kawasaki

doi:10.1186/s13052-020-0815-7

Abstract

BackgroundAlthough 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.MethodsWe 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.ResultsComparing 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).ConclusionsAmong 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.

Highlights

Disseminated intravascular coagulation (DIC) is a critical disease [1,2,3], there is few gold standard interventions in neonatal medicine
We previously reported that coagulation parameters, such as prothrombin time-international normalized ratio (PT-INR), activated prothrombin time, and D-dimer are all affected by placental abruption (PA), birth asphyxia and intravascular hemorrhage (IVH)
Of the 985 neonates admitted to our Neonatal Intensive Care Unit (NICU) between January 2010 and December 2017, 609 consecutive neonates born at 22–41 weeks were assessed for coagulation factors within the first 12 h of life, as previously described [8]

Summary

Introduction

Disseminated intravascular coagulation (DIC) is a critical disease [1,2,3], there is few gold standard interventions in neonatal medicine. Go et al Italian Journal of Pediatrics (2020) 46:54 reported rTM to be effective for DIC in both pediatric and adult patients [5, 6]. We reported gestational age (GA) and birth weight (BW) to be related to coagulation parameters [8]. It is important to measure coagulation parameters in ill neonates with perinatal risk factors for DIC at birth and diagnose DIC in neonates. The aims of this study were to investigate the underlying conditions affecting DIC at birth and to assess the effectiveness of rTM and FFP therapy. 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

Objectives

Methods

Results