Coagulation Activation, Fibrinolysis and Inhibitors in Neonates

Enhanced coagulation activation with reduced antithrombin III (ATIII) activity was seen in healthy neonates. Although systemic tissue plasminogen activator (t-PA) and urokinase-like plasminogen activator (u-PA) levels showed no significant differences from normal adults, enhanced fibrinolysis was indicated by elevated D-dimer and low plasminogen levels in the neonates in this study. Enhanced fibrinolysis observed was countered by elevated plasminogen activator inhibitor-1 (PAI-1) levels, a trend similar to that observed in the amniotic fluid during labour. The elevated PAI-1 level seen in neonates may have a beneficial effect in preventing haemorrhage in the neonatal period. The haemostatic and fibrinolytic mechanisms studied in normal pregnancy neonates were similar to neonates born to gestational diabetes mellitus (GDM) mothers. Further studies need to include neonates With poor outcome and low Apgar score to assess their haemostatic status.