Disseminated intravascular coagulation in pediatric intensive care: etiopathogenesis, clinical and diagnostic criteria, and treatment (literature review)

Disseminated intravascular coagulation (DIC) in children is an acute coagulopathy characterized by systemic activation of hemostasis. This article presents a review of current literature on the etiopathogenesis, diagnosis, and management of pediatric DIC in intensive care settings. Particular attention is paid to the clinical differences between neonates and older children, which necessitate individualized diagnostic and therapeutic strategies. Key triggers of coagulopathy are discussed, including the role of tissue factor, pro-inflammatory cytokines, and endothelial dysfunction. A functional typology of DIC (overt and non-overt forms) is analyzed alongside clinical and laboratory criteria, including the ISTH scoring system. Diagnostic limitations in pediatric patients are outlined, such as the lack of age-specific reference values, difficulties in interpreting laboratory markers, and the requirement for serial clinical-laboratory monitoring. The therapeutic section covers principles of transfusion support, etiological treatment, and anticoagulant strategies, including the use of heparins, antithrombin, activated protein C, and recombinant thrombomodulin. The limited evidence base for most of these interventions in pediatric populations is emphasized, underscoring the need for cautious when prescribing them. The core challenge of DIC in pediatric intensive care lies in the absence of validated diagnostic algorithms tailored to children, a lack of multicenter clinical trials, and the prevailing extrapolation of adult data, all of which hinder the development of standardized pediatric intensive care protocols.

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