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Coagulation defects in neonates during cardiopulmonary bypass
F H Kern1, N J Morana, J J Sears
1Department of Anesthesiology, Children's Hospital, Boston, Massachusetts.
The Annals of Thoracic Surgery
|September 1, 1992
Summary
Deep hypothermic cardiopulmonary bypass (CPB) significantly reduces neonatal coagulation factors and platelets due to hemodilution. Treatment for post-CPB coagulopathy in neonates should address these global deficits.
Area of Science:
- Pediatric Cardiology
- Hematology
- Cardiovascular Surgery
Background:
- Neonates undergoing deep hypothermic cardiopulmonary bypass (CPB) are at risk for coagulopathy.
- Understanding the impact of CPB on neonatal coagulation is crucial for patient management.
Purpose of the Study:
- To investigate the effects of deep hypothermic CPB on the coagulation system in neonates.
- To identify the primary drivers of coagulopathy during neonatal CPB.
Main Methods:
- Coagulation profiles were assessed in 30 neonates before, during, and after deep hypothermic CPB.
- Evaluated parameters included activated clotting time, prothrombin time, partial thromboplastin time, coagulation factors (II, V, VII, VIII, IX, X, I), antithrombin III, platelet count, and heparin levels.
Main Results:
- CPB initiation caused a 50% decrease in coagulation factors and antithrombin III.
- Platelet counts dropped by 70% upon CPB initiation.
- Deep hypothermia and extracorporeal surface exposure did not further impact coagulation profiles.
Conclusions:
- Hemodilution is the primary cause of profound, global coagulation deficits in neonates undergoing CPB.
- Neonatal post-CPB coagulopathy necessitates treatment strategies targeting these widespread deficiencies.