DIC screening in the newborn

Although reliable hemostasis screening in the newborn is difficult to obtain, the information gained from such testing is essential in differentiating the inherited from the acquired bleeding disorder. Sick infants are at risk for developing hemorrhage or thrombosis in response to a variety of diseases or injuries. Screening tests must be interpreted using appropriate normal ranges for term or preterm infants. Neonates are particularly susceptible to DIC because of their underdeveloped reticuloendothelial system and their tendency to develop acidosis, hypothermia, hypoxia, and shock. Bleeding is commonly the results of intravascular coagulation or decreased synthesis of clotting factors by the liver. Criteria based on clinical and laboratory findings have been determined in adults; however, these criteria are not necessarily applicable to neonates. A study reviewing 74 cases of newborns with suspected DIC reported that the most reliable diagnostic tests are the platelet count, D-dimer or FDP, PT, PTT, and fibrinogen. Whatever the test, the nurse's accurate assessment of the neonate, careful collection of blood, and reporting of abnormal results remain paramount in obtaining timely, appropriate care.