Disseminated fibrin thromboembolism among neonates dying within 48 hours of birth.

The cause of death within 7 days of birth remains uncertain in about 14% of neonates (Butler and Bonham, 1963). Many authors have commented on the presence of thrombosis in neonatal deaths, for example, Cruickshank (1930) noted thrombosis in 30 of 800 deaths. Zuschlag (1947) reported a study of lung infarction in 38 children, one ofwhom was less than a month old. These infarctions were frequently associated with thrombi and often related to infection. More recently, Emery (1953) made a similar observation, two of his cases being 51 days and 9 days old, respectively; no aetiology was apparent in the younger case. Groniowski (1963) reported 15 more cases and while at least half of them had obvious infections (mainly otitis media), the pulmonary thrombi were not obviously infected. Lately, Scott (1965) and Sanerkin, Edwards, and Jacobs (1966) have reported thrombosis with and without embolism as a consequence of prolonged umbilical vein catheterization. Dieckmann (1936) established that cases of abruptio placentae and concealed accidental haemorrhage showed hypofibrinogenaemia, and that the fatal cases showed widespread pulmonary thrombosis and embolism. This view received support from Schneider (1950, 1951), McKay, Merrill, Weiner, Hertig, and Reid (1953), and Johnstone and McCallum (1956). The lesions were localized at capillary level and the circulating blood became depleted of fibrinogen. Schneider showed that placenta and uterine decidua were very rich in tissue thromboplastin, and suggested that this substance was released into the circulation during one of these catastrophes to lead to the pathological and histological findings described above. Further studies have shown the syndrome of hypofibrinogenaemia of pregnancy to be a complex state involving at times the fibrinolytic system (Stefanini, 1958; Phillips, 1959; Schneider, 1959; Sherry, Fletcher, and Alkjaersig, 1959; Stefanini and Turpini, 1959;