Diffuse Intravascular Coagulation (DIC) As the Cause of Death in Hypothermic New-Borns and Infants

Abstract • 134

Objective: Hypothermia is defined as a core body temperature (BT) of 35°C or lover. Cold injury syndrome is a special clinical entity recognized in our region. This kind of accidental hypothermia, may be classified as mild (BT 32,1-36°C), moderate (BT 28,1-32°C) or severe (BT<28°C) and results in multiple systemic derangements. It can be manifested in new-borns and younger infants most often in winter time. These disturbances lead to circulatory collapse resulting in DIC.

Materials and methods: We analysed 103 medically treated children, especially 36 who died in the Pediatric department Clinical Hospital Split in the period from 1974 to 1985, with the signs of hypothermia and the organ injuries already expressed.

Results: 13 (12,62%) children were in age of 0-5 days of life; 44 (42,72%) in age of 6-10 days; 23 (22,33%) 11-15 days; 15 (14,56%) 16-30 days; 5 (7,76%) 30-60 days. There were 61 boys (59,22%) and 42 girls (40,78%). 84 infants (81,55%) were in severe, while 19 (18,45%) were in moderate conditions at admission. All children manifested cold skin and limbs, while 93,20% were sleepy, hypotonic and adinamic. Even 77,66% were cyanotic while 74,76% had scleredema. Other symptoms were bradicardia, bradipnea, jaundice, apnoic crisis, vomiting, seizures and secondary infections. According to the anamnestic data the previous duration of the disease was very short, most often one day. 36 children died, which amounts to 34,95%. Among them polyglobulia was registered in 72,22%, leucopenia in 80,55%, trombocytopenia 91,66%, hypoglycaemia 55,00%. 77,78% patients who died because of cold injury syndrome were younger than 15 days. All children who died of hypothermia had DIC, respiratory distress syndrome with apnoic crisis and metabolic acidosis. There were no differences in death rate between boys and girls. Eight of them had BT bellow 25°C, and seven of them died, while 50% of children with BT among 25,1-26°C survived. The death rate decreased with the rise of temperature taken at reception.

Conclusion: Cold injury syndrome is a serious hypothermic condition, with high mortality rate because of severe coagulation disturbances leading to DIC and multiple organ injuries, predominantly lungs.

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Čulić, S., Pavlov, N., Čulić, V. et al. Diffuse Intravascular Coagulation (DIC) As the Cause of Death in Hypothermic New-Borns and Infants. Pediatr Res 45, 765 (1999). https://doi.org/10.1203/00006450-199905010-00164

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