Document Detail

Blood loss and short-term outcome of infants undergoing brain tumour removal.
MedLine Citation:
PMID:  18615240     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate perioperative management, early outcomes and hemocoagulative disorders in infants up to 1 year old, undergoing neurosurgery for brain tumors removal. DESIGN: Retrospective evaluation of prospectively collected data regarding all infants aged <1 year admitted to PICU from 1994 to 2004, following intracranial mass removal. INTERVENTIONS: none. SETTING: University Hospital PICU in a tertiary neurosurgical referral centre. PATIENTS AND PARTICIPANTS: All eligible infants were enrolled in the study. Population was constituted by 43 infants and subdivided in two groups, according to their intra-operative blood loss. Babies having blood loss exceeding the preoperative estimated volemia were classified in group A; the remaining babies were included in group B. RESULTS: Intraoperative transfusions, PICU length of stay, need for post-operative mechanical ventilation and cardiovascular support were all significantly higher in group A than in group B. No early postoperative mortality occurred. ROC analysis and multiple logistic regression showed the age as the only variable independently associated with blood loss exceeding preoperative volemia (cut-off 60.3 days; OR = 0.11, CI 0.02-0.55, sensitivity 82.4%; specificity 67%). Postoperatively, platelet count, prothrombin activity and fibrinogen resulted significantly depressed in group A, representing a dilutional coagulopathy. A marked dispersion of aPTT values was recorded in group B, where most infants exhibit aPTT shortening, suggesting a hypercoagulability status. Three episodes of clinical disseminated intravascular coagulation (DIC) were registered in group B. CONCLUSIONS: We illustrated the relationships between intraoperative blood loss, transfusions and haemostatic impairment in babies following brain tumor removal. Youngest infants had the higher risk to experience hemocoagulative disorders. These infants showed significantly higher impact on the global PICU burden of care, as represented by the need of mechanical ventilation, cardiovascular support and PICU length of stay.
Marco Piastra; Concezio Di Rocco; Elena Caresta; Giulia Zorzi; Daniele De Luca; Massimo Caldarelli; Giuseppe La Torre; Giorgio Conti; Massimo Antonelli; Simon Eaton; Domenico Pietrini
Publication Detail:
Type:  Journal Article     Date:  2008-07-10
Journal Detail:
Title:  Journal of neuro-oncology     Volume:  90     ISSN:  0167-594X     ISO Abbreviation:  J. Neurooncol.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-02     Completed Date:  2009-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8309335     Medline TA:  J Neurooncol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  191-200     Citation Subset:  IM    
Pediatric Intensive Care Unit, Catholic University "A. Gemelli" Hospital, L.go Gemelli 8, Rome 00168, Italy.
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MeSH Terms
Blood Loss, Surgical / statistics & numerical data*
Brain Neoplasms / surgery*
Craniotomy / adverse effects*
Disseminated Intravascular Coagulation / etiology
Hematocrit / methods
Infant, Newborn
Intensive Care Units, Pediatric / statistics & numerical data
Partial Thromboplastin Time / methods
Respiration, Artificial / methods,  statistics & numerical data
Retrospective Studies
Treatment Outcome

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