Neonatal sepsis: A challenge in hemostaseology

Several therapeutic approaches to sepsis and disseminated intravascular coa gulation (DIC) have shown promising results in animal models. Large control led trials in humans, however, have failed to show a clearly beneficial eff ect of a single drug or substance on outcome and survival so that treatment remains uncertain. As one researcher stated: "... sepsis is a classical ex ample of a disease greater than the sum of its parts; it is a complex proce ss in which intervention in one area might have only a modest effect on the final outcome." We believe that the complex pathophysiological setting of septic shock will undoubtedly require a multifaceted approach. Consequently , we attempt to arrest DIC and restore adequate tissue perfusion by interve ntion with heparin, AT and if possible protein C (PC) in the earliest stage of the disease, with the aim of blocking ongoing microthrombus formation a nd to support fibrinolysis. Growing understanding of the basic underlying mechanisms teaches us how to successfully stabilise the individual decompensated sub-systems like coagul ation in septic patients. We should learn to accept these steps to reach th e goal of a better outcome in terms of survival in this devastating illness .