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[Disseminated intravascular coagulation in newborn infants with infection]
Insights
Treating sepsis-related disseminated intravascular coagulation (DIC) in infants requires tailored approaches. Early-stage DIC (hypercoagulation) benefits from cryoplasma, while later stages need antithrombin/antiplasmin drugs and blood product support.
Area of Science:
- Pediatrics
- Hematology
- Infectious Diseases
Background:
- Sepsis in infants frequently leads to disseminated intravascular coagulation (DIC), a complex hemostatic disorder.
- Effective management of DIC in this population requires a nuanced understanding of coagulation abnormalities.
Purpose of the Study:
- To outline a staged treatment strategy for DIC in infants with sepsis based on the degree of hemostatic imbalance.
- To differentiate therapeutic interventions for hypercoagulation and hypocoagulation phases of DIC.
Main Methods:
- Review and synthesis of current therapeutic guidelines for DIC in pediatric sepsis.
- Classification of DIC into stages based on hypercoagulation and hypocoagulation.
Main Results:
- Stage I DIC (hypercoagulation) management focuses on restoring thrombin and plasmin system inhibitors, achievable with donor cryoplasma alone.
- Stages II (transitory) and III (hypocoagulation) DIC necessitate antithrombin and antiplasmin agents, blood component therapy, and management of hemorrhagic complications.
Conclusions:
- A staged, multimodality treatment approach is crucial for managing sepsis-induced DIC in infants.
- Therapy must be individualized according to the specific hemostatic derangements observed in each stage of DIC.
Abstract:
The treatment of disseminated intravascular coagulation (DIC) in infants with sepsis should be instituted after multimodality therapy of pyo-inflammatory diseases taking into account the degree of hemostatic disorders. In stage I DIC (hypercoagulation one), it is necessary to reach an adequate level of the inhibitors of the thrombin and plasmin systems. In this case it is quite sufficient to use donor's cryoplasma without heparin administration. In stage II DIC (transitory one) and stage III (hypocoagulation one), it is required that the drugs possessing antithrombin and antiplasmin activity, substitution therapy with blood preparations and components as well as measures to control hemorrhagic diathesis may be used.