Comparison between thromboelastography and conventional coagulation tests after cardiopulmonary bypass surgery in the paediatric intensive care unit.

INTRODUCTION: Following paediatric cardiac surgery using cardiopulmonary bypass (CPB), there is a risk of significant postoperative bleeding. A number of risk factors are associated with postoperative bleeding including; age, complexity of the surgery, dilution and consumption of clotting factors. We conducted a prospective audit comparing different coagulation tests used following paediatric CPB to determine whether thromboelastography (TEG) on the intensive care unit or routine laboratory coagulation assays including fibrinogen are better at assessing bleeding and bleeding risk. METHODS: Tests on arrival in paediatric intensive care unit (PICU) included the following: fibrinogen, prothrombin time, activated partial thromboplastin time, full blood count and TEG. Bleeding was measured in the first 1-4 h via chest drain loss. Bleeding was considered significant if ≥5 ml/kg/h. RESULTS: Of 107 patients admitted to PICU, 23/107 were considered to be bleeding during the first hour. Fibrinogen concentration had the best correlation with the amount of first-hour blood loss (r(s) = 0.52), followed by APTT (r(s) = 0.44) and TEG MA (r(s) = 0.34). TEG parameter TEG MA correlated with platelet count (r(s) = 0.68) and fibrinogen (r(s) = 0.66). CONCLUSIONS: Thromboelastography did not show better correlation with postoperative bleeding than conventional clotting tests. TEG parameter maximum amplitude correlates with platelet count and fibrinogen.

Very low birth weight infants have only few adverse events after timely immunization.

INTRODUCTION: Premature infants should be vaccinated at the appropriate vaccinating age, without correcting for their gestational week and regardless of their weight. Uncertainty with regard to possible severe adverse events exists among physicians. METHODS: In all, 473 patients with a birth weight under 1500 g were included in a prospective observational study for adverse events that included cardiorespiratory events, local reactions and fever. Three vaccination combinations were used at different time periods. RESULTS: The median birth weight was 910 (375 to 1495) g. Gestational week at birth was 27.6 (22.6 to 34.3). At the time of vaccination, the gestational week was 37.4 (31.5 to 48.3). The frequency of adverse events for local reactions/fever was 2.8% and for apnea/bradycardia it was 10.8%. Apnea appeared significantly more often in children who were younger at the time of immunization. This is in concordance with the fact that they were also younger at birth. If apnea appeared, the chance of the development of bradycardia had an odds ratio of 6.4 (3.2:13.0). Children with higher-grade hemorrhages and/or with periventricular leukomalacia did not experience more adverse events, except fever. CONCLUSION: Timely vaccination of premature infants with a birth weight under 1500 g is safe, but the occurrence of cardiorespiratory events is related to earlier gestational week.