Association of Preoperative Anemia With Postoperative Mortality in Neonates

Abstract

outcome. We agree that it is the critical illness itself that poses the inherent risk, not surgical complexity. The eTable in the Supplement compares those neonates with a recorded preoperative hematocrit (n = 2764) with those without a recorded preoperative hematocrit (n = 925). Dr Hall believes that we selected out the more unwell infants and therefore the results are skewed. We acknowledge that neonates with a recorded preoperative hematocrit are likely to be critically ill. However, after adjusting for the factors associated with critical illness, anemia exacerbates, by a factor of 2, the mortality risk associated with critical illness. Clearly, preoperative anemia, defined as hematocrit less than 40%, is strongly associated with postoperative mortality.Anemia was the focus in this article because it is the one preoperative factor that can be optimized in our vulnerable surgical neonatal population, not only by a blood transfusion but more importantly by prudent blood conservations strategies when time allows. We hope that by providing the clinician with the valuable information that a low hematocrit in neonates increases postoperative mortality, survival may improve.