Association between anemia and postoperative complications in infants undergoing pyloromyotomy

Kedir, Habib; Miller, Rebecca; Syed, Faizaan; Hakim, Mohammed; Walia, Hina; Tumin, Dmitry; McKee, Christopher; Tobias, Joseph D.

doi:10.1016/j.jpedsurg.2019.01.059

Cited by 5 publications

(4 citation statements)

References 35 publications

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“…Although a higher incidence of in-hospital mortality has been reported in anemic neonates and children presenting for non-cardiac surgery, it is important to consider this in the context which was extremely ill children for complex surgical procedures [ 62 , 63 ]. Preoperative anemia, defined as hematocrit <40% for neonates and <30% for infants >30 days old as well as toddlers to adolescents, in otherwise healthy children < 1 year of age has not been associated with PRCs in the setting of uncomplicated surgeries [ 64 ].…”

Section: Preoperative Risk Assessment and Stratificationmentioning

confidence: 99%

“…A systematic review with meta-analyses of randomized controlled trials comparing a restrictive versus liberal transfusion strategy in both adult and pediatric patients reported no differences in mortality or morbidity between the two strategies, despite reduced number of packed red blood cells used and less patients transfused [ 94 ]. The general consensus is that the underlying cause of the anemia should be determined and treated if possible in order to minimize the risk of transfusion-related PRC [ 64 , 95 , 96 ].…”

Section: Preoperative Risk Assessment and Stratificationmentioning

confidence: 99%

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Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Egbuta

Mason

2020

JCM

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There have been significant advancements in the safe delivery of anesthesia as well as improvements in surgical technique; however, the perioperative period can still be high risk for the pediatric patient. Perioperative respiratory complications (PRCs) are some of the most common critical events that can occur in pediatric surgical patients and they can lead to increased length of hospitalization, worsened patient outcomes, and higher hospital and postoperative costs. It is important to determine the various factors that put pediatric patients at increased risk of PRCs. This will allow for more detailed and accurate informed consent, optimized perioperative management strategy, improved allocation of clinical resources, and, hopefully, better patient experience. There are only a few risk prediction models/scoring tools developed for and validated in the pediatric patient population, but they have been useful in helping identify the key factors associated with a high likelihood of developing PRCs. Some of these factors are patient factors, while others are procedure-related factors. Some of these factors may be modified such that the patient’s clinical status is optimized preoperatively to decrease the risk of PRCs occurring perioperatively. Fore knowledge of the factors that are not able to be modified can help guide allocation of perioperative clinical resources such that the negative impact of these non-modifiable factors is buffered. Additional training in pediatric anesthesia or focused expertise in pediatric airway management, vascular access and management of massive hemorrhage should be considered for the perioperative management of the less than 3 age group. Intraoperative ventilation strategy plays a key role in determining respiratory outcomes for both adult and pediatric surgical patients. Key components of lung protective mechanical ventilation strategy such as low tidal volume and moderate PEEP used in the management of acute respiratory distress syndrome (ARDS) in pediatric intensive care units have been adopted in pediatric operating rooms. Adequate post-operative analgesia that balances pain control with appropriate mental status and respiratory drive is important in reducing PRCs.

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Section: Preoperative Risk Assessment and Stratificationmentioning

confidence: 99%

Section: Preoperative Risk Assessment and Stratificationmentioning

confidence: 99%

Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Egbuta

Mason

2020

JCM

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“…Iron deficiency is one of the most common nutrient deficiencies. It can lead to anemia and related dysfunctions and it's estimated that worldwide, nearly 30% of the population who are iron deficient will also have anemia (Dickson et al., 2019; Kedir et al., 2019). Iron deficiency is usually prevented and treated with iron supplementation, which has a number of associated side effects.…”

Section: Introductionmentioning

confidence: 99%

Determination of the iron bioavailability, conformation, and rheology of iron‐binding proteins from Tegillarca granosa

Zhan

et al. 2020

J. Food Biochem.

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Iron deficiency is one of the most common nutrient deficiencies. It can lead to anemia and related dysfunctions and it's estimated that worldwide, nearly 30% of the population who are iron deficient will also have anemia (Dickson et al., 2019; Kedir et al., 2019). Iron deficiency is usually prevented and treated with iron supplementation, which has a number of associated side effects. For example, an excess amount of residual iron with low bioavailability can promote the growth of intestinal pathogens, causing the hepatic inflammation (Koji et al., 2018). About 10% of our daily iron needs normally come from our diet (Zhang et al., 2018) and there has been an increased scientific interest in identifying iron-rich foods and examining iron bioavailability with the aim of helping supplement iron levels through diet. Tegillarca granosa (T. granosa), also known as the blood clam, is an important commercial marine bivalve widely distributed along the coasts of the Indo-Pacific region (Jin et al., 2011). Although T. granosa is rich in heme iron and has been described as a high-quality food source of iron, the quantity, type, and bioavailability of the iron in T. granosa has not been fully investigated. While iron can exist in the iron-binding proteins (IBPs) hemoglobin and ferritin (Sun & Guo, 2012).

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“…13 In contrast, a single-centre retrospective study in infants aged <1 year undergoing pyloromyotomy found that preoperative anemia was not associated with postoperative complications. 14 Lower preoperative hemoglobin (Hb) levels have also been shown to be an independent risk predictor for allogenic blood transfusion in pediatric neurosurgical and cardiac patients. 15,16 An increased prevalence of anemia may result in increased postoperative complications in pediatric surgical noncardiac patients in LMICs.…”

mentioning

confidence: 99%

The association between preoperative anemia and postoperative morbidity in pediatric surgical patients: A secondary analysis of a prospective observational cohort study

Meyer

Torborg

Cronjé

et al. 2020

Pediatric Anesthesia

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Background The prevalence of anemia in the South African pediatric surgical population is unknown. Anemia may be associated with increased postoperative complications. We are unaware of studies documenting these findings in patients in low‐ and middle‐income countries (LMICs). Aim The primary aim of this study was to describe the association between preoperative anemia and 26 defined postoperative complications, in noncardiac pediatric surgical patients. Secondary aims included describing the prevalence of anemia and risk factors for intraoperative blood transfusion. Method This was a secondary analysis of the South African Paediatric Surgical Outcomes Study, a prospective, observational surgical outcomes study. Inclusion criteria were all consecutive patients aged between 6 months and <16 years, presenting to participating centers during the study period who underwent elective and nonelective noncardiac surgery and had a preoperative hemoglobin recorded. Exclusion criteria were patients aged <6 months, undergoing cardiac surgery, or without a preoperative Hb recorded. To determine whether an independent association existed between preoperative anemia and postoperative complications, a hierarchical stepwise logistic regression was conducted. Results There were 1094 eligible patients. In children in whom a preoperative Hb was recorded 46.2% had preoperative anemia. Preoperative anemia was independently associated with an increased risk of any postoperative complication (odds ratio 2.0, 95% confidence interval: 1.3‐3.1, P = .002). Preoperative anemia (odds ratio 3.6, 95% confidence interval: 1.8‐7.1, P < .001) was an independent predictor of intraoperative blood transfusion. Conclusion Preoperative anemia had a high prevalence in a LMIC and was associated with increased postoperative complications. The main limitation of our study is the ability to generalize the results to the wider pediatric surgical population, as these findings only relate to children in whom a preoperative Hb was recorded. Prospective studies are required to determine whether correction of preoperative anemia reduces morbidity and mortality in children undergoing noncardiac surgery.

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Association between anemia and postoperative complications in infants undergoing pyloromyotomy

Cited by 5 publications

References 35 publications

Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient

Determination of the iron bioavailability, conformation, and rheology of iron‐binding proteins from Tegillarca granosa

The association between preoperative anemia and postoperative morbidity in pediatric surgical patients: A secondary analysis of a prospective observational cohort study

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