Normal and disordered coagulation in the neonate

Over the past 10–15 yr, improvements in perinatal and neonatal care and in the laboratory diagnosis and monitoring of coagulation disorders have lead to significant reductions in morbidity and mortality from bleeding and thrombosis in sick and low birth-weight infants. Recent advances in our understanding of the normal developmental changes that occur in the coagulation mechanism of the fetus and newborn now allow for more intelligent and rational approaches to the treatment of disordered coagulation and fibrinolysis. This review will focus on current knowledge of the normal changes that occur in the coagulation mechanism during late fetal development and early infancy. Subsequent discussion will deal with how developmental aspects of the coagulation mechanism impact upon morbidity and mortality from common neonatal diseases. The diagnosis and management of specific bleeding and thrombotic syndromes of neonates will also be discussed. Finally, a brief overview of the indications for use of plasma products in neonatal medicine will be presented.