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Signa vitae : journal for intesive care and emergency medicine, Vol. 8 No. 2, 2013.

Original scientific paper

Thromboelastometry in neonates and infants undergoing cardiac surgery

MOJCA GROSELJ-GRENC ; Department of Paediatric Surgery and Intensive Care, University Medical Centre, Bohoriceva 20, 1525 Ljubljana, Slovenia
GORAZD KALAN ; Department of Paediatric Surgery and Intensive Care, University Medical Centre, Bohoriceva 20, 1525 Ljubljana, Slovenia
ENVER MELKIC ; Institute of Clinical Chemistry and Biochemistry, University Medical Centre, Zaloska 7, 1525 Ljubljana, Slovenia

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Abstract

Introduction. Rotational thromboelastometry (ROTEM) in monitoring coagulation in children undergoing cardiac surgery has been studied with promising results. Since the data about ROTEM in infants and neonates undergoing cardiac surgery are scarce, the aim of our study was to asses ROTEM abnormalities in this patient group. Methods. Infants and neonates undergoing cardiac surgery on cardiopulmonary bypass were included in this prospective, observational study conducted in a level III multidisciplinary neonatal and pediatric intensive care unit (ICU) between May 2011 and January 2012. ROTEM analysis, together with determination of platelet count, international normalized ratio of prothrombin time (INR), activated partial thromboplastin time (PTT), and fibrinogen concentration, was done in all neonates and infants before surgery (t
1 ), after admission to ICU (t
2 ) and 24 hours after surgery (t
3 ).
Results. Twenty infants and neonates were operated on during the time of the study. ROTEM abnormalities seen after surgery (t
2 ) were: thrombocytopenia 14, hypofibrinogenemia 1, mixed hypofibrinogenemia and coagulation factor deficiency
1, and mixed thrombocytopenia with mild hyperfibrinolysis 1. Three patients were found to have normal ROTEM results. The median values of all except one of the ROTEM tests, as well as platelet count, INR, PTT, and fibrinogen concentration, showed significant prolongation or deterioration after admission to ICU and these deteriorations persisted in several parameters for 24 hours. Conclusions. In our neonates and infants, cardiac surgery on cardiopulmonary bypass predominantly affects platelets, although most of the ROTEM parameters deteriorated after admission to ICU.

Keywords

thromboelastometry; cardiac surgery; neonate; infant; thrombocytopenia; hypofibrinogenemia

Hrčak ID:

110339

URI

https://hrcak.srce.hr/110339

Publication date:

1.10.2013.

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