Bleeding in Critically Ill Children—Review of Literature, Knowledge Gaps, and Suggestions for Future Investigation

Aran, Adi; Karam, Oliver; Nellis, Marianne

doi:10.3389/fped.2021.611680

Cited by 3 publications

(2 citation statements)

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“…Приймання антикоагулянтів у післяопераційному періоді можуть спричинити вторинні кровотечі шлунковокишкового тракту. До того ж самі кардіохірургічні втручання та такі їх фактори, як штучний кровообіг, його тривалість, глибина та час гіпотермії, ступінь недостатності кровообігу після відновлення серцевої діяльності також можуть підвищувати ризики геморагічних ускладнень гастроінтестинального тракту [7].…”

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“…Рання діагностика шлунково-кишкових кровотеч має включати визначення інтенсивності кровотечі та важкості крововтрати, показників гемодинамічної стабільності, локалізацію її джерела за допомогою лабораторних і додаткових методів дослідження, таких як ендоскопія, яку рекомендують виконувати протягом 2 діб від початку кровотечі. Для оцінювання тяжкості кровотечі, стандартизації її діагностики та прискорення надання допомоги, деякі дослідники рекомендують використовувати стандартні шкали, зокрема шкалу Bleeding Assessment Scale in Critically Ill Children (BASIC), що була розроблена мультидисциплінарною командою спеціалістів та затверджена Делфійським консенсусом [7,8].…”

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A Case of Duodenal Bleeding in a One-Year-Old Child in the Early Postoperative Period after the Surgical Correction of Congenital Heart Defect

Tsymbal,

Boyko

2023

ujcvs

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Background. Gastrointestinal bleeding in children is a rather rare pathology. This especially applies to the bleeding in the postoperative period after surgical interventions that are not related to the pathology of the gastrointestinal tract. As a result, clinicians are not alert to the occurrence of such complications, which, in turn, can lead to late diagnosis and delay in the treatment of bleeding. Case report. We present a clinical case of duodenal bleeding in a one-year-old child in the early postoperative period after radical repair of ventricular septal defect by patching the defect. Laboratory parameters on admission: hemoglobin 120 g/L, red blood cells 4.37×1012/L. On the first postoperative day, hemoglobin was 103 g/L, hematocrit was 33%. On the 5th day after the operation, the boy had a currant jelly stool. Hemostatic therapy was provided: transfusion of fresh frozen plasma at a dose of 10 mL/kg, single administration of tranexamic acid at a dose of 10 mg/kg. The bleeding was stopped. After hemostatic therapy, hemoglobin was 105 g/L, hematocrit was 31%. Within 24 hours, fibrogastroduode-noscopy was performed which revealed an ulcer of the duodenal bulb covered with fibrin. The boy was consulted by gastroenterologist. Pathogenetic therapy was prescribed: proton pump inhibitors, antacids, enveloping drugs. The child was discharged home in a satisfactory condition on the 15th day after the operation under the supervision of a district pediatrician, cardiologist, and gastroenterologist. Laboratory parameters at discharge: hemoglobin 91 g/L, red blood cells 3.3×1012/L. Conclusion. The problem of gastrointestinal complications, including gastrointestinal bleeding in young children af-ter cardiac surgery, is extremely insufficiently covered in the scientific literature. Many questions remain unsolved re-garding the prevention, early diagnosis and treatment of bleeding, so research in this field remains relevant for both clinicians and scientists.

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A Case of Duodenal Bleeding in a One-Year-Old Child in the Early Postoperative Period after the Surgical Correction of Congenital Heart Defect

Tsymbal,

Boyko

2023

ujcvs

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Perioperative considerations in the paediatric patient with congenital and acquired coagulopathy

Erdoes,

Goobie,

Haas

et al. 2024

BJA Open

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Short-term neurologic outcomes in pediatric extracorporeal membrane oxygenation are proportional to bleeding severity graded by a novel bleeding scale

Doane,

Guffey,

Loftis

et al. 2024

Perfusion

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Introduction This study aimed to characterize the severity of bleeding and its association with short-term neurologic outcomes in pediatric ECMO. Methods Multicenter retrospective cohort study of pediatric ECMO patients at 10 centers utilizing the Pediatric ECMO Outcomes Registry (PEDECOR) database from December 2013-February 2019. Subjects excluded were post-cardiac surgery patients and those with neonatal pathologies. A novel ECMO bleeding scale was utilized to categorize daily bleeding events. Poor short-term neurologic outcome was defined as an unfavorable Pediatric Cerebral Performance Category (PCPC) or Pediatric Overall Performance Category (POPC) (score of >3) at hospital discharge. Results This study included 283 pediatric ECMO patients with a median (interquartile range [IQR]) age of 1.3 years [0.1, 9.0], ECMO duration of 5 days [3.0, 9.5], and 44.1% mortality. Unfavorable PCPC and POPC were observed in 48.4% and 51.3% of patients at discharge, respectively. Multivariable logistic regression analysis included patient’s age, cannulation type, duration of ECMO, need for cardiopulmonary resuscitation, acute kidney injury, new infection, and vasoactive-inotropic score. As the severity of bleeding increased, there was a corresponding increase in the likelihood of poor neurologic recovery, shown by increasing odds of unfavorable neurologic outcome (PCPC), with an adjusted odds ratio (aOR) of 0.77 (confidence interval [CI] 0.36–1.62), 1.87 (0.54–6.45), 2.97 (1.32–6.69), and 5.56 (0.59–52.25) for increasing bleeding severity (grade 1 to 4 events, respectively). Similarly, unfavorable POPC aOR (CI) was 1.02 (0.48–2.17), 2.05 (0.63–6.70), 5.29 (2.12–13.23), and 5.11 (0.66–39.64) for bleeding grade 1 to 4 events. Conclusion Short-term neurologic outcomes in pediatric ECMO are proportional to the severity of bleeding events. Strategies to mitigate bleeding events could improve neurologic recovery in pediatric ECMO.

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Bleeding in Critically Ill Children—Review of Literature, Knowledge Gaps, and Suggestions for Future Investigation

Cited by 3 publications

References 68 publications

A Case of Duodenal Bleeding in a One-Year-Old Child in the Early Postoperative Period after the Surgical Correction of Congenital Heart Defect

A Case of Duodenal Bleeding in a One-Year-Old Child in the Early Postoperative Period after the Surgical Correction of Congenital Heart Defect

Perioperative considerations in the paediatric patient with congenital and acquired coagulopathy

Short-term neurologic outcomes in pediatric extracorporeal membrane oxygenation are proportional to bleeding severity graded by a novel bleeding scale

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