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Semin Thromb Hemost
DOI: 10.1055/a-2823-8395
Review Article

Neonatal Sepsis-Induced Coagulopathy: An Evolving Frontier at the Crossroads of Inflammation and Hemostasis

Authors

  • Rozeta Sokou 

    1   Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece, National and Kapodistrian University of Athens, Medical School, Athens, Greece

  • Alexandra Lianou 

    2   NICU, a. Neonatal Intensive Care Unit, "Agios Panteleimon" General Hospital of Nikea, Piraeus, Greece., Athens, Greece

  • Eleni Gounari

    3   Paediatric Assessment Unit, g. East Sussex Hospitals NHS Trust, Hastings, UK., Hastings, United Kingdom of Great Britain and Northern Ireland

  • Andreas G. Tsantes 

    4   Microbiology Department, "Saint Savvas" Oncology Hospital, Athens, Greece., Athens, Greece

  • Stefanos Bonovas 

    5   Department of Biomedical Sciences, Humanitas University, Milan, Italy, Milan, Italy

  • Georgios Nikolopoulos

    6   Medical School, University of Cyprus, Nicosia, Cyprus, University of Cyprus, Nicosia, Cyprus, Nicosia, Cyprus

  • Argirios E. Tsantes

    7   Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece., Athens, Greece

  • Nicoletta Iacovidou

    8   Neonatal Department,, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece, Athens, Greece
Further Information
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Sepsis is defined as life-threatening organ dysfunction, caused by a dysregulated host immune response to an infection. Sepsis is often associated with significant hemostatic disorders that may lead to extensive intravascular thrombosis, disseminated intravascular coagulation (DIC), multi-organ dysfunction syndrome (MODS) and increased mortality. Sepsis-induced coagulopathy (SIC) is currently recognized as an early distinct phase of hemostatic derangement caused by sepsis, and a prodrome of overt DIC. SIC is characterized by endovascular clotting activation, hypercoagulability, and consumption of clotting factors and platelets. DIC, traditionally considered the final stage of this process, is now recognized as a part of a continuum of pathophysiological dysregulation with a distinct clinical significance. Despite being extensively studied in the adult population, SIC remains poorly defined in neonates. The distinct characteristics of neonatal hemostasis, coupled with immunological immaturity pose significant challenges to the direct application of adult diagnostic approaches of SIC in this population. This review focuses on the pathophysiological mechanisms of SIC and the unique characteristics of neonatal hemostasis and summarizes current knowledge regarding the underlying mechanisms of neonatal SIC and explores the developmental interplay between inflammation and hemostasis. By integrating current evidence, the review aims to establish a conceptual framework that will guide future experimental and clinical studies directed toward improving the management and outcomes of neonates who develop coagulopathy during sepsis.



Publication History

Received: 22 October 2025

Accepted after revision: 26 February 2026

Accepted Manuscript online:
27 February 2026

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