The evaluation and management of neonatal coagulation disorders

Background Coagulation involves a series of physiological cascades. Unlike its adult counterpart, neonatal blood coagulation system is evolving and the concentrations of some clotting-related proteins are relatively lower. Objective To review studies in neonatal blood coagulation in order to guide early diagnosis, treatment and prevention of the neonatal bleeding and clotting disorders. Content Coagulation is controlled by a balance between coagulating and anti-coagulating processes. For instance, coagulation is triggered by vascular injuries, is initiated by adjacent platelets and activated coagulating factor Ⅶ, and develops when platelets bind to von Willibrands factor and collagens. Protein C deactivates some coagulating factors, and inhibits coagulation. In neonates, these molecules are all at lower concentrations, and some of them even exist in immature format. As neonatal blood coagulation function is evaluated by routine blood tests with references for adults, it is difficult to screen neonates with potential coagulating disorders. The common causes of neonatal bleeding include primary bleeding diseases[i.e. hemophilia and von willebrand disease(vWD)] and bleeding that follows cardiovascular surgery and necrotizing enterocolitis, etc. Trend Standard references for neonatal blood tests should be specified to a particular development stage in terms of blood coagulation. More clinical trials are needed to further characterize neonatal blood coagulation system and to optimize the treatment of bleeding diseases. Key words: Neonate; Coagulation disorders; Bleeding