title: Predictors of postoperative bleeding in children undergoing cardiopulmonary bypass: A preliminary Italian study.
abstract: BACKGROUND
  Several characteristics such as demographics, pre-existing conditions, surgical procedure, perioperative coagulopathy may predispose children undergoing cardiopulmonary bypass (CPB) to bleeding complications. As yet, studies on risk factors for postoperative bleeding have brought mixed results. The purpose of our study was therefore to retrospectively evaluate the parameters able to predict postoperative bleeding in a group of consecutive children undergoing cardiac surgery involving CPB.
  
  
  METHODS
  We collected demographic and perioperative laboratory data, as well as intraoperative transfusion requirements and blood loss during the first 24h after surgery in a group of consecutive children (aged ≥1month) scheduled for cardiac surgery with CPB at Padua University Hospital between June 2014 and April 2015. Cases were patients who experienced a 24-h postoperative blood loss ≥80th percentile. Univariate and multivariate logistic regression analyses were performed to determine the independent parameters associated with a high 24-h postoperative chest tube drainage volume.
  
  
  RESULTS
  Eighty-three children (M:F 38:45; age range 1-168months) were enrolled. Age<7.7months (p 0.015), postoperative platelets <109×109/L (p 0.003) and postoperative D-dimer ≥2350μg/L (p 0.007) were the variables most significantly and independently associated with excessive 24-h postoperative blood loss.
  
  
  CONCLUSIONS
  Although preliminary, our study identified younger age, lower postoperative platelet count and higher D-dimer plasma levels as possible risk factors for postoperative bleeding. As for coagulation parameters, our results suggested consumptive coagulopathy might cause a strong predisposition to postoperative bleeding in children. Large-scale prospective studies would provide insight into the early diagnosis and treatment of CPB-related coagulopathies.
authors.affiliation: Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Spiezia
authors.affiliation: Cardiac Anaesthesia Unit, Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Di Gregorio
authors.affiliation: Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Campello
authors.affiliation: Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Maggiolo
authors.affiliation: Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bortolussi
authors.affiliation: Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Stellin
authors.affiliation: Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, University of Padua, Padua, Italy. Electronic address: paolo.simioni@unipd.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Simioni
authors.affiliation: Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Vladimiro
authors.initials: V
authors.lastname: Vida
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001777:Blood Coagulation; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000097:blood* / Q000175:diagnosis / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Cardiac surgical procedures; Consumptive coagulopathy; Haemorrhage