Children undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at increased risk for postoperative bleeding and transfusion requirement. Perioperative management of neonates undergoing cardiac surgery is much more challenging because the CPB priming volume is usually as high as the circulating blood volume, the immaturity of the coagulation system increases the magnitude of perioperative coagulopathy, and this population usually undergoes more complex surgical procedures at low temperatures.

Although bleeding management is increasingly studied in the paediatric population, only a few studies have focused on neonates. Guzzetta et al. have performed the first large retrospective study with the aim of assessing the incidence of adverse events associated with excessive postoperative bleeding in neonates undergoing cardiac surgery with CPB. The authors observed a significant correlation between 24-hour chest tube output, lower body weight, increased Risk Adjustment for Congenital Heart Surgery (RACHS-1) score, CPB duration, and lower temperature. In addition, bleeding was independently associated with the incidence of postoperative dialysis and the requirement for extracorporeal membrane oxygenation.

Although the design used in this retrospective analysis could not exclude potential unmeasured confounding variables, this study highlights the need for further studies with the aim of improving perioperative bleeding management in neonates undergoing cardiac surgery.

– David Faraoni

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