Early Diagnostic Laboratory Tests of Disseminated Intravascular Coagulation in Newborn Infants

ABSTRACT

PURPOSE: The peak incidence of disseminated intravascular coagulation(DIC) in the pediatric age group is in the neonatal period. The objective was to determine the early diagnostic laboratory tests of DIC in newborn infants. METHODS: 46 neonates with DIC, admitted between January 1995 and November 1998 in NICU of Chungnarn National University Hospital, were compared with 49 newborn infants in control group. We checked platelet counts, PT, aPTT, FDP, fibrinogen and AT III in both groups. We defined abnormality of laboratory tests of DIC as values which outranged 2 S.D. of control group means. In DIC group, serial laboratory tests were performed in 35 patients. RESULTS: Symptoms or signs suggestive of DIC were abdominal distension(40%), bleeding(35%), apnea(15%), and lethargy(15%). The incidence of infection was 65%, and the incidence of keeping endotracheal tube, arterial line, umbilical venous catheterization, TPN and asphyxia was about 40%. Sensitivity of laboratory tests was as follows: fibrinogen was 63%, platelet count 59%, aPTT 49%. And specificity was 100% for FDP, 96% for platelet count, and 93% for fibrinogen. 22 patients showed at least one of the initially normal values changed to abnormal during follow up tests. The percentage of transition was 83% for fibrinogen and 64% for platelet count. In DIC group, 34 patients (74%) improved, but 12(26%) died. CONCLUSION: This study suggests that the most reliable initial diagnostic laboratory tests in DIC are fibrinogen and platelet counts.