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Ann Thorac Surg 1992;54:541-546
© 1992 The Society of Thoracic Surgeons

Articles

Coagulation defects in neonates during cardiopulmonary bypass

Frank H. Kern, MD*, Nicholas J. Morana, BS, John J. Sears, BS, Paul R. Hickey, MD

Department of Anesthesiology, The Children's Hospital, Boston, and Harvard Medical School, Boston, Massachusetts USA

Accepted for publication February 17, 1992.

* Address reprint requests to Dr Kern, Duke University Medical Center, Box 3046, Durham, NC 27710.

We examined components of the coagulation system in 30 neonates (age, 1 to 30 days) undergoing deep hypothermic cardiopulmonary bypass (CPB). A coagulation profile consisting of activated clotting time; prothrombin time; partial thromboplastin time; factors II, V, VII, VIII, IX, X, and I (fibrinogen); antithrombin III; platelet count; and heparin levels was evaluated before bypass, at three intervals during bypass (1 minute after initiation of bypass, stable hypothermic CPB, warm CPB), after weaning from CPB and administration of protamine, and 2 to 3 hours after skin closure. The initiation of CPB resulted in a 50% decrease in circulating coagulation factors and antithrombin III levels. Platelet counts were reduced by 70% with CPB initiation. Neither deep hypothermic temperatures nor prolonged exposure to extracorporeal surfaces had any additional effect on the coagulation profiles. This suggests that the coagulation system of a neonate undergoing CPB is profoundly and globally effected by hemodilution. We believe that treatment of post-CPB coagulopathy in neonates must address these global deficits.




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