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Meier N. Anesthetic Considerations for Pediatric Craniofacial Surgery. Anesthesiol Clin 2021; 39:53-70. [PMID: 33563386 DOI: 10.1016/j.anclin.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Anesthetic management of craniosynostosis remains a challenging experience. It requires input and collaboration from multiple specialties to improve patient outcomes. Understanding the surgical corrective techniques and the underlying risks of each is essential to providing the best care to this patient population. The propensity for significant blood loss necessitates fundamental knowledge of pediatric resuscitation and the development of perioperative transfusion protocols that have been shown to reduce transfusion requirements in the peri-operative period.
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Affiliation(s)
- Nicholas Meier
- Department of Anesthesiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Haidl H, Pohl S, Leschnik B, Gallistl S, Muntean W, Schlagenhauf A. Neonatal thrombocytopenia: Thrombin generation in presence of reduced platelet counts and effects of rFVIIa in cord blood. Sci Rep 2019; 9:8014. [PMID: 31142810 PMCID: PMC6541708 DOI: 10.1038/s41598-019-44199-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 05/07/2019] [Indexed: 11/12/2022] Open
Abstract
Healthy neonates exhibit a well-functioning haemostatic system despite peculiarities regarding composition of clotting factors and inhibitors as well as impaired platelet aggregation. Thrombocytopenia and severe bleeding events are feared in sick infants. Recombinant factor VIIa (rFVIIa) is a haemostatic agent used as a last resort in neonates with refractory bleedings. Aim of this study was to investigate in-vitro (i) changes in thrombin generation with different platelet counts, (ii) effects of rFVIIa under conditions of thrombocytopenia and (iii) potentially differing dose-response of rFVIIa in cord blood as a surrogate for neonatal blood compared to adult blood. Thrombin generation parameters were observed in cord blood plasma and adult plasma with various platelet counts, with or without addition of rFVIIa, respectively. Low platelet counts did not influence thrombin generation in cord blood in contrast to adult blood. RFVIIa primarily affected lag time throughout all platelet concentrations. Interestingly, peak height was reduced exclusively in cord blood plasma after addition of rFVIIa. No significant differences regarding dose-response were observed between cord blood and adult blood. In contrast to adult blood, thrombocytopenia in cord blood does not significantly influence thrombin generation. Even at very low platelet counts there is enough negatively charged surface to support rFVIIa action in plasma from cord blood and adult blood in-vitro.
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Affiliation(s)
- Harald Haidl
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Sina Pohl
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bettina Leschnik
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Siegfried Gallistl
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Wolfgang Muntean
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Axel Schlagenhauf
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
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Cosar H, Isik H, Cakır SC, Yar N, Goksen B, Tokbay H, Kertmen H, Erdoğan N, Durak I. Recombinant Activated Factor VIIa (rFVIIa) Treatment in Very-Low-Birth-Weight (VLBW) Premature Infants with Acute Pulmonary Hemorrhage: A Single-Center, Retrospective Study. Paediatr Drugs 2017; 19:53-58. [PMID: 27826851 DOI: 10.1007/s40272-016-0203-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM We aimed to evaluate the efficacy of intravenous administration of recombinant activated factor VIIa (rFVIIa) for acute pulmonary hemorrhage treatment in very-low-birth-weight (VLBW) premature infants. PATIENTS AND METHODS This study was carried out retrospectively in premature infants with pulmonary hemorrhage that were ≤30 weeks gestational age or <1250 g birth weight. The data of all VLBW premature infants with pulmonary hemorrhage who were hospitalized in our neonatal intensive care unit between 01 January 2013 and 31 December 2015 were evaluated. Group 1 (n = 21) received rFVIIa support within the first 30 min of pulmonary hemorrhage plus conventional treatment, while Group 2 (n = 21) received conventional treatment only. RESULTS The number of patients whose pulmonary hemorrhage was stopped within the first 2 h was significantly higher in Group 1 than Group 2 (n = 14 vs n = 4; p = 0.002). After pulmonary hemorrhage, hemoglobin values of Group 1 were higher than Group 2 (11.12 ± 1.06 vs 10.14 ± 1.59 g/dL; p = 0.024). Erythrocyte suspension (1.43 ± 4.51 vs 5.71 ± 7.46 mL/kg; p = 0.030) and fresh frozen plasma use (5.71 ± 8.10 vs 19.52 ± 12.44 mL/kg; p < 0.001) in Group 1 were lower than those of Group 2. Prothrombin time, activated partial thromboplastin time, and international normalized ratio values in Group 1 were lower than those of Group 2 (p < 0.05). No statistically significant difference was identified in recurrence of pulmonary hemorrhage after 72 h, overall mortality, mortality from pulmonary hemorrhage, surfactant use, intubation time, hospitalization duration, intraventricular hemorrhage (IVH), severe IVH, patent ductus arteriosus rates, or short-term complication rates. CONCLUSION rFVIIa administration was observed to be effective in stopping pulmonary hemorrhage, reducing blood product requirement, and improving coagulation test parameters. Prospective studies are needed to evaluate the efficacy, reliability, and long-term results of rFVIIa in the prevention and treatment of pulmonary hemorrhage in premature infants.
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Affiliation(s)
- Hese Cosar
- Neonatal Intensive Care Unit, Private Egepol Hospital, 507 Street, No: 3, 35270, Konak, Izmir, Turkey.
| | - Halil Isik
- Neonatal Intensive Care Unit, Private Egepol Hospital, 507 Street, No: 3, 35270, Konak, Izmir, Turkey
| | - Salih Cagrı Cakır
- Neonatal Intensive Care Unit, Private Egepol Hospital, 507 Street, No: 3, 35270, Konak, Izmir, Turkey
| | - Nese Yar
- Neonatal Intensive Care Unit, Private Egepol Hospital, 507 Street, No: 3, 35270, Konak, Izmir, Turkey
| | - Bulent Goksen
- Neonatal Intensive Care Unit, Private Egepol Hospital, 507 Street, No: 3, 35270, Konak, Izmir, Turkey
| | - Hakan Tokbay
- Neonatal Intensive Care Unit, Private Egepol Hospital, 507 Street, No: 3, 35270, Konak, Izmir, Turkey
| | - Hasan Kertmen
- Neonatal Intensive Care Unit, Private Egepol Hospital, 507 Street, No: 3, 35270, Konak, Izmir, Turkey
| | - Nihal Erdoğan
- Neonatal Intensive Care Unit, Private Egepol Hospital, 507 Street, No: 3, 35270, Konak, Izmir, Turkey
| | - Ikbal Durak
- Neonatal Intensive Care Unit, Private Egepol Hospital, 507 Street, No: 3, 35270, Konak, Izmir, Turkey
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Park HJ, Choi EJ. Use of Recombinant Activated Factor VII for Pulmonary Hemorrhage in Premature Infants: A Single-Center Experience. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2016. [DOI: 10.15264/cpho.2016.23.1.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hye Jin Park
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Eun Jin Choi
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
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Strauss T, Rozenzweig N, Rosenberg N, Shenkman B, Livnat T, Morag I, Fruchtman Y, Martinowitz U, Kenet G. Surfactant impairs coagulation in-vitro: A risk factor for pulmonary hemorrhage? Thromb Res 2013; 132:599-603. [DOI: 10.1016/j.thromres.2013.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/07/2013] [Accepted: 09/02/2013] [Indexed: 11/24/2022]
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Predicting response to rFVIIa in neonates with intractable bleeding or severe coagulation disturbances. J Pediatr Hematol Oncol 2013; 35:221-6. [PMID: 23511491 DOI: 10.1097/mph.0b013e318286d27e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To date, clinical experience with recombinant factor VIIa (rFVIIa) in neonates is rather limited because of the lack of controlled studies. ΑIM: The objective of this study was to present further experience from our center with regard to the use of rFVIIa in newborns with severe bleeding or coagulopathy resistant to conventional therapy and to determine factors affecting the clinical outcome. METHODOLOGY We performed a retrospective data analysis of 29 neonates with intractable bleeding or severe coagulation disturbances. All patients received 100 μg/kg of rFVIIa per dose bolus intravenously (maximum of 23 doses), as rescue procedure after other interventions had failed to achieve hemostasis. RESULTS Fourteen neonates survived (group A), whereas 15 died (group B). There was no difference in birth weight, gestational age, and bleeding site and causes between the 2 groups. In the neonates who survived, rFVIIa had been administered earlier in the disease process (<24 h of beginning of bleeding) compared with those who died (P=0.009). In all 29 neonates, international normalized ratio was directly restored (from 2.99±1.4 before rFVIIa administration to 1.6±1.1 afterward, P<0.001) and prothrombin time and activated partial thromboplastin time were significantly decreased after administration of rFVIIa (from 28 to 16.4 and from 180 to 67, respectively; P=0.001 and 0.05, respectively). Blood products administered were significantly less in group A than in group B, as time from the beginning of bleeding to the administration of rFVIIa was significantly less in group A than in group B. Neither acute adverse events nor thromboembolic complications were observed. CONCLUSIONS In this neonatal group with intractable bleeding and/or severe coagulation disturbances, rFVIIa was more effective in early intervention as rescue therapy, without any adverse events in all neonates. Upon failure to achieve hemostasis with initial administration of blood products, fast intervention with rFVIIa could be considered in neonates with serious bleeding and coagulation disorders.
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