COAGULATION, FIBRINOLYTIC AND KALLIKREIN SYSTEMS IN NEONATES WITH UNCOMPLICATED SEPSIS AND SEPTIC SHOCK

This study evaluates the contact system, coagulation inhibitors and fi brinolysis in 23 full-term newborns with sepsis (8 with septic shock). The results were compared with a group of 20 healthy newborns. Blood samples were obtained at the time of clinical diagnosis and 3 days aft er the antibiotic therapy was started. The results showed that: severe infection was associated with activation of the contact system, deple tion of anticoagulant proteins and elevation of C4b-binding protein le vels. There was a shift in protein S to the complexed inactive form, a nd the thrombin-antithrombin complexes increased. These changes occurr ed in parallel to both activation and inhibition of fibrinolysis. Thes e changes were more pronounced in the septic shock patients than in no nshock neonates. After therapy, this procoagulant state decreased amon g survivor patients while in those who died, the abnormalities in coag ulation did not improve. Our study suggests that neonatal sepsis induc es a hypercoagulable state that persists in nonsurvivor neonates despi te a correct treatment.