Disseminated fibrin thromboembolism among neonates dying more than 48 hours after birth.

Of 119 neonates dying after 48 hours of life, 19 (16%) showed disseminated fibrin thromboembolism, a histological condition that is very similar to one form of maternal hypofibrinogenaemia. The incidence is nearly five times that among stillbirths and neonates dying within 48 hours of birth. Most of the mothers had a normal pregnancy, labour, and puerperium. One twin may show the condition while the other survives. It is suggested that the affected infants have either no fibrinolytic mechanism, a defective one, or one which for some unaccountable reason was not brought into action. The antecedent plasma fibrinogen level is likely to have been high in some cases, but a fatal outcome can ensue with normal or low levels. The process was considered to be totally responsible for death in six cases (5%) of the series. Renal tubular hyaline droplets apparently rich in haemoglobin were only encountered in one infant (no. 4) who died from massive bilateral adrenal haemorrhage. In the later part of the neonatal period, the process is liable to be indistinguishable clinically from secondary thrombotic processes, which occurred with almost the same incidence in the present series (14(12%) of 119 cases).