Study of protein C, protein S, and antithrombin III in hypoxic newborns.
OBJECTIVE
The aim of this study was to clarify the effect of hypoxia on the physiologic inhibition system of coagulation including protein S, protein C, and antithrombin III and to study their effect on thromboembolic accidents of hypoxic newborns.


METHODS
Clinical study including ten hypoxic-ischemic neonates and ten normal neonates as a control group.


METHODS
MEDLINE, pediatric textbooks, neonatal intensive care unit, Department of Paediatrics, Faculty of Medicine, Cairo University.


RESULTS
The results of this study revealed a marked decrease in the level of the physiologic inhibition system of coagulation including antithrombin III, protein C, and protein S in 100% of the hypoxic-ischemic neonates compared with the control group (p <.001) before the occurrence of thromboembolic complications. Fifty percent of the hypoxic-ischemic neonates developed disseminated intravascular coagulation and died, 40% developed necrotizing enterocolitis and rectal bleeding, 20% developed hematuria, 30% developed hematemesis, 20% developed intracranial hemorrhage, and 100% had convulsions.


CONCLUSIONS
In this study, we evaluated the effect of asphyxia on the physiologic inhibition system of coagulation in neonates. Care providers should suspect hypoxia resulting from any obstructed labor and perform the necessary laboratory investigations for coagulation, including antithrombin III, protein C, and protein S levels, to help prevent thromboembolic accidents in asphyxiated neonates, including disseminated intravascular coagulation, necrotizing enterocolitis, and intracranial hemorrhage. Based on the development of antithrombin III and protein C concentrates, which are commercially available, require minimal monitoring, and have very few side effects, the time is ripe for evaluation of optimal treatment for thromboembolic accidents after neonatal asphyxia. This could be even more important if successful neuroprotectant strategies are also developed.
El Beshlawy
Amal
A
Department of Paediatrics, Faculty of Medicine, Cairo University, Egypt.
Hussein
Heba Abou
HA
Abou-Elew
Heba Hassan
HH
Abdel Kader
Mohamed Salah Eldin Mohamed
MS
D000990:Antithrombin III / Q000037:antagonists & inhibitors*; D001237:Asphyxia / Q000150:complications; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D020345:Enterocolitis, Necrotizing / Q000209:etiology; D005260:Female; D006396:Hematemesis / Q000209:etiology; D006417:Hematuria / Q000209:etiology; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000097:blood* / Q000209:etiology; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000209:etiology; D008297:Male; D011486:Protein C / Q000037:antagonists & inhibitors*; D017293:Protein S / Q000037:antagonists & inhibitors*; D012640:Seizures / Q000209:etiology
D011486:Protein C; D017293:Protein S; D000990:Antithrombin III