The relationship between coagulation and the extend of surgery and postoperative infection in surgical infants below 6 months of age.
OBJECTIVE
First to assess coagulation changes after surgery in children below 6 months of age. Second to detect differences attributable to the extent of surgery and postoperative infection.


METHODS
Blood counts, haemoglobin concentration (Hb), haematocrit (Ht), prothrombine time (PT), activated partial thromboplastine time (aPTT) and thrombelastography (TEG) were studied pre- and 2+/-1/2 d postoperatively. Patients were divided in 3 groups. I: minor surgery without access to the abdomen or thorax (n=51); II: abdominal or thoracic interventions (n=24); III: abdominal surgery with postoperative sepsis (n=11).


RESULTS
Preoperative values of Hb, Ht and INR were related to the age of the infant. Postoperatively clot strength and formation rate increased in gr. I (p<0.05). In gr. II, clot formation was initiated earlier (p<0.05) even though PT decreased (p<0.05). In group III, patients postoperatively developed a tendency for hypocoagulability in all TEG-parameters, but not in plasmatic coagulation. Postoperative TEG measurements were significantly inferior in gr. III when compared to gr. I and II.


CONCLUSIONS
Our findings suggest activation of whole blood coagulation in the uncomplicated postoperative period despite of a decrease in plasmatic coagulation. In sepsis, only thrombelastography, but not plasmatic coagulation was affected.
Kessler
Ulf
U
Department of Surgical Pediatrics, Inselspital, Bern, Switzerland. ulf.kessler@insel.ch
Guenther
Patrick
P
Zachariou
Zacharias
Z
D000367:Age Factors; D001777:Blood Coagulation / Q000502:physiology*; D001780:Blood Coagulation Tests; D006801:Humans; D007223:Infant; D013511:Minor Surgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000097:blood*; D011379:Prognosis; D018805:Sepsis / Q000097:blood*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013916:Thrombelastography