The relationship between coagulation and the extend of surgery and postoperative infection in surgical infants below 6 months of age

Abstract

Aim: 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. Materials and methods: Blood counts, haemoglobin concen-tration (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. Conclusion: 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. © 2006 - IOS Press and the authors. All rights reserved.