Incidence of disseminated intravascular coagulation in the course of septicemia in newborn infants

Abstract

Abstract. Coagulation studies including platelet count, partial thrombop]astin time, prothrombin index, and assays of fibrinogen, prothrombin, proaccelerin, antihcmophilic globuline and fibrin(ogen) degradation products were carried out in 12 newborn infants afflicted with septicemia. All patients had a decrease of platelet counts. 8 patients showed characteristic signs of DIC. In 3 cases we found marked consumption and in 3 other cases mild forms of DIC. In 2 cases DIC had occurred a few days before we obtained samples. The remaining 4 patients exhibited as a result of endotoxinemia a low platelet count without affecting blood coagulation. The most reliable laboratory findings for the diagnosis of DIC seem to be reduced platelet counts and low levels of fibrinogen and factor V. Poor prognosis and a high mortality rate still characterize cases of septicemia in newborn infants. The immunological situation, the absence of Ig A and Ig M, and a frequent deficiency of pathognomonic symptoms are the causes most frequently cited [17,18]. As thrombocytopenia is a frequent finding in the course of septicemia in newborn infants, we attempted to determine, whether this is due to disseminated intravascular coagulation (DIC). Thromboeytopenia associated with a decrease of certain plasma coagulation factors and with secondary Key-Words:

The coagulation system in septic newborns

“…In contrast to earlier reports, dependence of the dynamics on the type of bacteria could not be established [19]. Severe forms of consumption coagulopathy were not often observed in our group: this confirms the findings of other authors [6,11,35], and bleeding occurred only rarely and in a mild form [1,35]. Other authors here assumed that in many cases the endotoxins or the bacteria are the cause of isolated thrombocytopenia through reaction with the thrombocytes or the endothelium.…”

“…Remarkable differences between the initial values of survivors and of patients who subsequently died could not be demonstrated but the coagulation parameters are of great diagnostic significance [1,21,22,34,35]. Individual parameters, for instance the fibrinogen level or the thrombocyte count, are of minor importance.…”

“…In the first place, those components which were found on average to be elevated in the beginning of the disease increased considerably, sometimes after an initial decrease of short duration. The fibrinogen level may rise within a few hours [1,6,21,34] and has therefore been termed an 'acute phase reaction' [21], as has the increase of trypsin inhibitory capacity [15]. But other components--the factors II and X and antiptasmin--have also a share in this reaction, and in view of the turbulent dynamics it seems rather difficult to decide which of them may be categorized as an 'acute phase reactant.'…”

“…To date there are reports on thrombocytopenia [1,6,8,11,21,23,24] and on increased as well as reduced fibrinogen levels [6,21,34], also on decreased factor II and factor V values [1,6,34,35], and on reduction of other components of the coagulation system. Alpha 1-antitrypsin was found to have increased in the course of sepsis in newborns [15,16].…”

“…Alpha 1-antitrypsin was found to have increased in the course of sepsis in newborns [15,16]. The changes are classified mainly as two types: consumption coagulopathy caused by disseminated intravascular coagulation (DIC) and thrombocytopenia occurring without other defects and caused by mechanisms other than DIC [1,6,11,19,24,34]. It is the purpose of this paper to analyze the coagulation parameters in a large group of septic newborns, especially the results of extensive progress examinations in the course of the disease.…”