Neonatal asphyxia and renal failure as the presentation of non-inherited protein C deficiency

Inherited or acquired protein c (pc) deficiency leads to thromboembolic events. plasma pc activity in infancy is physiologically lower than in adults. we describe a case of neonatal asphyxia and acute renal failure associated with isolated pc deficiency. a full-term male infant was born to a healthy mother by caesarean section because of fetal distress. the small-for-gestational age infant showed 2 and 7 of apgar scores at 1 and 5 minutes, respectively. hypercoagulability required repeated infusions of fresh frozen plasma. coagulation study revealed pc activity, 6%, protein s activity, 61%, and high d-dimer levels, along with normal factor vii activity and absent vitamin k deficiency. anticoagulant and activated pc therapy improved coagulopathy and nephropathy. imaging analyses indicated no visceral infarctions. renal function and pc activity have been slowly normalized until 6 months of age. he had no proc mutation or pc-deficient parents. selective pc deficiency may occur as an acquired cause of hypercoagulable crisis in the stressed newborn.