From the Guidelines
Management of DIC-related skin necrosis in neonates requires a multidisciplinary approach, including a dermatologist, to plan wound management and rotation of neonatally appropriate wound irrigation products, as recommended by the British Journal of Dermatology in 2024 1. The initial treatment focuses on addressing the underlying cause of DIC while providing supportive care. Replace depleted coagulation factors with fresh frozen plasma (10-15 mL/kg) and cryoprecipitate (5-10 mL/kg) to correct coagulation abnormalities. Platelet transfusions (10-15 mL/kg) are indicated for counts below 50,000/μL or with active bleeding. For skin necrosis, gentle wound care is essential using saline cleansing and non-adherent dressings.
- Avoid debridement of necrotic tissue until the patient is stabilized.
- Use antimicrobial soaks for nonsymptomatic positive wound cultures, and rotate antimicrobials if using long term, as suggested by the British Journal of Dermatology in 2024 1. Pain management is crucial, and according to the British Journal of Dermatology in 2024 1,
- sucrose, paracetamol/acetaminophen, and/or oral morphine/oxycodone can be used as first-line medications for pain relief, especially for degloved wounds.
- Nonmedication-based pain relief strategies, such as swaddling, patting, rocking, calm music, and singing, can be used as standalone relief or in conjunction with medication. Monitor coagulation parameters (PT, PTT, fibrinogen, D-dimer) frequently to guide therapy. Maintain adequate hydration and correct electrolyte imbalances. The prognosis depends on the extent of necrosis and underlying condition, with early intervention improving outcomes by preventing further tissue damage and supporting the body's natural healing processes.
From the Research
DIC Skin Necrosis Management in Neonates
- Disseminated intravascular coagulation (DIC) is a serious secondary disease that can lead to microclots in the peripheral vasculature, consuming the body's clotting factors and precipitating bleeding 2.
- Neonates are at a greater risk of developing DIC due to their slightly altered hemostasis, also known as developmental coagulopathy 2.
- The management of DIC in neonates involves addressing the underlying condition, and some coagulation-specific therapies have been explored, including the use of recombinant thrombomodulin (rTM) and fresh frozen plasma (FFP) 3.
- The effectiveness of rTM and FFP for DIC in neonates has been assessed, with results showing that rTM in combination with FFP therapy was effective for neonatal DIC at birth 3.
- It is essential to protect neonatal skin integrity and prevent neonatal skin injury in the neonatal intensive care unit (NICU) to reduce the risk of infection and death 4.
Risk Factors and Treatment
- Birth asphyxia is a significant risk factor associated with DIC in neonates at birth 3.
- Other risk factors include small for gestational age (SGA), low Apgar score, hemangioma, hydrops, pregnancy-induced hypertension (PIH), and persistent pulmonary hypertension (PA) 3.
- Treatment of DIC in neonates aims to reverse the underlying condition, and coagulation-specific therapies have been explored, including the use of rTM and FFP 3, 5.
- Global coagulation tests and single-factor plasma levels must be interpreted in the context of age-corrected normal ranges to diagnose DIC in neonates 5.