Blood Utilization in Neonates and Infants Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass

2011 ◽  
Vol 2 (3) ◽  
pp. 382-392 ◽  
Author(s):  
Mark C. Wesley ◽  
Koichi Yuki ◽  
Dima G. Daaboul ◽  
James A. DiNardo
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Utilization ◽  
Neonates And Infants

scholarly journals Perioperative serum albumin and its influence on clinical outcomes in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass: a multi-centre retrospective study

2019 ◽  
Vol 29 (06) ◽  
pp. 761-767 ◽  
Author(s):  
Brandon M. Henry ◽  
Santiago Borasino ◽  
Laura Ortmann ◽  
Mayte Figueroa ◽  
A.K.M. Fazlur Rahman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Retrospective Study ◽  
Cardiopulmonary Bypass ◽  
Serum Albumin ◽  
Serum Albumin Level ◽  
Albumin Level ◽  
Critically Ill Children ◽  
Operative Morbidity ◽  
Neonates And Infants ◽  
Low Serum

AbstractHypoalbuminemia is associated with morbidity and mortality in critically ill children. In this multi-centre retrospective study, we aimed to determine normative values of serum albumin in neonates and infants with congenital heart disease, evaluate perioperative changes in albumin levels, and determine if low serum albumin influences post-operative outcomes. Consecutive eligible neonates and infants who underwent cardiac surgery with cardiopulmonary bypass at one of three medical centres, January 2012–August 2013, were included. Data on serum albumin levels from five data points (pre-operative, 0–24, 24–48, 48–72, 72 hours post-operative) were collected. Median pre-operative serum albumin level was 2.5 g/dl (IQR, 2.1–2.8) in neonates versus 4 g/dl (IQR, 3.5–4.4) in infants. Hypoalbuminemia was defined as <25th percentile of these values. A total of 203 patients (126 neonates, 77 infants) were included in the study. Post-operative hypoalbuminemia developed in 12% of neonates and 20% of infants; 97% occurred in the first 48 hours. In multivariable analysis, perioperative hypoalbuminemia was not independently associated with any post-operative morbidity. However, when analysed as a continuous variable, lower serum albumin levels were associated with increased post-operative morbidity. Pre-operative low serum albumin level was independently associated with increased odds of post-operative hypoalbuminemia (OR, 3.67; 95% CI, 1.01–13.29) and prolonged length of hospital stay (RR, 1.40; 95% CI, 1.08–1.82). Lower 0–24-hour post-operative serum albumin level was independently associated with an increased duration of mechanical ventilation (RR, 1.35; 95% CI, 1.12–1.64). Future studies should further assess hypoalbuminemia in this population, with emphasis on evaluating clinically meaningful cut-offs and possibly the use of serum albumin levels in perioperative risk stratification models.

Neutrophil gelatinase-associated lipocalin reflects inflammation and is not a reliable renal biomarker in neonates and infants after cardiopulmonary bypass: a prospective case–control study

2017 ◽  
Vol 28 (2) ◽  
pp. 243-251 ◽  
Author(s):  
Karl Reiter ◽  
Gunter Balling ◽  
Vittorio Bonelli ◽  
Jelena Pabst von Ohain ◽  
Siegmund Lorenz Braun ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Interleukin 6 ◽  
Inflammatory Diseases ◽  
Kidney Injury ◽  
Cardiopulmonary Bypass Time ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neonates And Infants ◽  
Neutrophil Gelatinase

AbstractIntroductionAcute kidney injury is a frequent complication after cardiac surgery with cardiopulmonary bypass in infants. Neutrophil gelatinase-associated lipocalin has been suggested to be a promising early biomarker of impending acute kidney injury. On the other hand, neutrophil gelatinase-associated lipocalin has been shown to be elevated in systemic inflammatory diseases without renal impairment. In this secondary analysis of data from our previous study on acute kidney injury after infant cardiac surgery, our hypothesis was that neutrophil gelatinase-associated lipocalin may be associated with surgery-related inflammation.MethodsWe prospectively enrolled 59 neonates and infants undergoing cardiopulmonary bypass surgery for CHD and measured neutrophil gelatinase-associated lipocalin in plasma and urine and interleukin-6 in the plasma. Values were correlated with postoperative acute kidney injury according to the paediatric Renal-Injury-Failure-Loss-Endstage classification.ResultsOverall, 48% (28/59) of patients developed acute kidney injury. Of these, 50% (14/28) were classified as injury and 11% (3/28) received renal replacement therapy. Both plasma and urinary neutrophil gelatinase-associated lipocalin values were not correlated with acute kidney injury occurrence. Plasma neutrophil gelatinase-associated lipocalin showed a strong correlation with interleukin-6. Urinary neutrophil gelatinase-associated lipocalin values correlated with cardiopulmonary bypass time.ConclusionOur results suggest that plasma and urinary neutrophil gelatinase-associated lipocalin values are not reliable indicators of impending acute kidney injury in neonates and infants after cardiac surgery with cardiopulmonary bypass. Inflammation may have a major impact on plasma neutrophil gelatinase-associated lipocalin values in infant cardiac surgery. Urinary neutrophil gelatinase-associated lipocalin may add little prognostic value over cardiopulmonary bypass time.

Specific requirements for bloodless cardiopulmonary bypass in neonates and infants; a review

Perfusion ◽  
2010 ◽  
Vol 25 (4) ◽  
pp. 237-243 ◽  
Author(s):  
Hanna D Golab ◽  
Johanna JM Takkenberg ◽  
Ad JJC Bogers
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Pediatric Patients ◽  
Survival Rates ◽  
Open Heart Surgery ◽  
Acceptable Level ◽  
Open Heart ◽  
Neonates And Infants ◽  
Safe Performance

A miniaturized cardiopulmonary bypass circuit enables the safe performance, in selected pediatric patients, of bloodless open heart surgery. As the latest survival rates in neonatal and infant cardiac surgery have become satisfactory, investigators have concentrated upon the improvement of existing procedures. Institutional guidelines and multidisciplinary efforts undertaken in the pre- and postoperative periods are of great importance, concerning bloodless CPB and should be seriously pursued by all involved caregivers. This review reflects upon the selective, most relevant requirements for success of asanguinous neonatal and infant CPB: acceptable level of hemodilution during the CPB, patient preoperative hematocrit value and volume of CPB circuit. We present an assessment of practical measures that were also adapted in our institution to achieve an asanguinous CPB for neonatal and infant patients.

scholarly journals Deep hypothermia combined with cardiopulmonary bypass for cardiac surgery in neonates and infants

1972 ◽  
Vol 64 (3) ◽  
pp. 422-429 ◽  
Author(s):  
Atsumi Mori ◽  
Ryusuke Muraoka ◽  
Yoshio Yokota ◽  
Yoshijumi Okamoto ◽  
Fumitaka Ando ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Deep Hypothermia ◽  
Neonates And Infants

Abstract 18061: Supplementation to Treat Antithrombin Deficiency Improves Sensitivity to Heparin, Anticoagulation and Decreased Thrombogenecity in Neonates and Infants Undergoing Cardiac Surgery With Cardiopulmonary Bypass

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Brian W McCrindle ◽  
Cedric Manlhiot ◽  
Helen M Holtby ◽  
Anthony K Chan ◽  
Leonardo R Brandao ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Severe Bleeding ◽  
Antithrombin Deficiency ◽  
Activated Clotting Time ◽  
Heparin Resistance ◽  
Heparin Anticoagulation ◽  
Outcome Trial ◽  
At Deficiency ◽  
Neonates And Infants

Introduction: Preoperative antithrombin (AT) deficiency is common in infants undergoing cardiac surgery with cardiopulmonary bypass (CPB), and is associated with heparin resistance, difficulties achieving optimal intraoperative anticoagulation and post-operative thrombosis. Methods: We performed a pilot randomized trial of pooled human AT supplementation for children <1 year with preoperative AT <0.85U/ml. Subjects received a split (patient and CPB prime) dose of AT before heparinization. AT was dosed to reach a predicted AT activity of 1.2U/ml during CPB calculated from preoperative AT level and patient weight. Results: We randomized 18 subjects; 17 completed the study (9 controls, 8 AT). Mean preoperative AT level was similar between groups (Control: 0.65±0.10 vs. AT: 0.68±0.15 U/mL, p=0.66). AT group subjects had higher AT than controls immediately after start of CPB (Control: 0.44±0.10 vs. AT: 1.15±0.20 U/mL, p<0.001) and at the end of CPB (Control: 0.67±0.14 vs. AT: 1.19±0.16 U/mL, p<0.001). AT supplementation was associated with increased activated clotting time (ACT) post-heparinization (Control: 500±72 vs. AT: 639±172 seconds, p=0.02), increased heparin sensitivity (Control: 89±23 vs. AT: 114±22 ACT seconds per 100U/kg heparin, p=0.02), and decreased heparin dose given during CPB (Control: 1126±344 vs. AT: 845±165 U/kg, p=0.03). After primary heparinization, 56% of control subjects did not achieve ACT target vs. 25% of AT subjects. At the end of CPB, AT group subjects had lower prothrombin levels (Control: 746±372 vs. AT: 460±102 ng/mL, p=0.02) and lower levels of inflammatory cytokines (IL-1α, IL-1β, IL-6, IL-8 and TNFα). Supplementation with AT was not associated with increased chest tube volume loss or blood product requirements. One subject in each group had severe bleeding, and one in each group had post-operative infection. Thrombosis was noted for 3 controls and 1 AT subjects. Conclusions: AT supplementation to treat preoperative AT deficiency in young children is associated with decreased heparin resistance, improved anticoagulation and decreased thrombogenecity. Safety profile regarding bleeding and infections appears favorable. Equipoise exists for a larger definitive outcome trial.

Sign in / Sign up

Export Citation Format

Share Document