PB0235 - Diagnosis, predisposing factors, and Management of Disseminated Intravascular Coagulation in neonatal Intensive care Unit in a tertiary Care Hospital

Background: Neonates are at a greater risk of developing Disseminated Intravascular Coagulation (DIC) because they are born with slightly altered hemostasis due to developmental coagulopathy. Because of the serious nature of this disease, it is important to diagnose and manage DIC in a timely manner.

Aims: This study was aimed at determining the diagnosis, predicting factors, and management of DIC in neonatal population admitted to NICU at our tertiary care hospital.

Methods: Neonates admitted to NICU at Cantonment General Hospital (CGH) from Jan 2019 to Dec 2021 were included in the study. The standard method of diagnosing DIC was based on sequential testing of the components of the ISTH scoring system (ie, prothrombin time [PT], platelet count, fibrinogen, and D-dimer). Patients' clinical notes were checked for predisposing factors and information was recorded on the proformas. Logistic regression analysis was done to assess the ability of the independent variables, such as PT, D-dimer, platelet count, and fibrinogen, to predict overt DIC according to the ISTH scoring system.

Results: Out of a total of 1365 neonates admitted to NICU at CGH, 180 (13%) were diagnosed as having DIC with a score of ≥5 based on ISTH criteria of diagnosing overt DIC. DIC in neonates was caused by prenatal risk factors, such as placental abruption (5%), pregnancy-induced hypertension (13%), and neonatal factors such as sepsis (51%), prematurity (20%), and asphyxia (11%). Treatment of DIC was mostly carried out by administering fresh frozen plasma (FFP), platelet transfusion, and treatment of underlying cause including administering antibiotics. Despite rigorous treatment, 29 patients ( 16%) died due to uncontrolled DIC.

Conclusion(s): In conclusion, the present study demonstrates that various factors are associated with neonatal DIC at birth, with sepsis among the most significant of these factors. Furthermore, FFP and platelet transfusion therapy are effective for treating neonatal DIC.