In 2022,China's National Health Commission issued the health standard"Guideline for pediatric transfusion"(WS/T 795-2022),which provides guidance and recommendations on overall pediatric blood requirements,blood for exchange transfusion,and the use of irradiated red blood cells,washed red blood cells,and fresh red blood cells.This article explains the rationale and evidence base underlying these recommendations to facilitate a clearer understanding of the guideline.

Background:Pediatric cardiac surgery requiring cardiopulmonary bypass (CPB) is associated with high transfusion rates. While transfusions increase risks of adverse events, existing evidence cannot differentiate whether risks arise from transfusion itself or cumulative volumes. This study aims to explore the relationship between intra-operative transfusion volume and adverse outcomes, exploring whether transfusion volume has a linear or threshold effect on adverse outcomes. Methods:This retrospective cohort study included pediatric patients (≤14 years old) undergoing cardiac surgery with CPB, categorized by intra-operative red blood cell (RBC) volume transfused: 0, 0.1-22.2 mL/kg, 22.3-27.0 mL/kg, 27.1-34.5 mL/kg and >34.5 mL/kg. Outcomes included prolonged mechanical ventilation (MV), acute kidney injury (AKI), severe AKI and composite complications (chest drainage >10 mL/kg/d, culture-confirmed pulmonary infection, extracorporeal membrane oxygenation (ECMO) implantation, and in-hospital mortality). Multivariable logistic regression was used to analyze the relationship between intra-operative RBC transfusion volume and outcomes. Results:A total of 19,081 children were included, of whom 44.5% received RBC transfusion during surgery. Among these, 10.7% received 0.1-22.2 mL/kg, 11.3% received 22.3-27.0 mL/kg, 11.3% received 27.1-34.5 mL/kg and 11.0% received >34.5 mL/kg RBC transfusion. Higher RBC transfusion volumes correlated with certain adverse events. However, after adjustment for potential confounders, no consistent linear dose-effect relationship was observed. Instead, a threshold-effect association was identified. Compared with no transfusion, RBC transfusion >34.5 mL/kg was associated with increased risks of prolonged MV [odds ratio (OR): 3.45, 95% confidence interval (CI): 2.78-4.28; P<0.001], AKI (OR: 1.21, 95% CI: 1.01-1.44; P=0.04), and composite complications (OR: 2.30, 95% CI: 1.54-3.43; P<0.001), whereas low-volume transfusion was inversely associated with composite complications (0.1-22.2 mL/kg: OR, 0.36; 95% CI: 0.17-0.76; P=0.007), prolonged MV (0.1-22.2 mL/kg: OR, 0.55; 95% CI: 0.40-0.77; P=0.001; 22.3-27.0 mL/kg: OR, 0.64; 95% CI: 0.48-0.85; P=0.002), and AKI (0.1-22.2 mL/kg: OR, 0.81; 95% CI: 0.68-0.95; P=0.01). Conclusions:In this large cohort of pediatric patients undergoing surgery for congenital heart disease (CHD), there was a threshold effect between intraoperative RBC transfusion volume and adverse outcomes. Besides, low-volume transfusion was inversely associated with these outcomes. These findings highlight the importance of evaluating RBC transfusion using weight-adjusted volume and suggest that an optimal transfusion range may exist in pediatric cardiac surgery.

Background Interrupted aortic arch with aortopulmonary window is a rare congenital entity that is associated with high morbidity and mortality.Such patients usually manifest symptoms of pulmonary overcirculation and systemic hypoperfusion in the neonatal period and need urgent surgical correction. Case presentation We report a 3-day-old neonate with type A IAA associated with type III APW who underwent successful one-stage surgical repair. The patient was extubated on postoperative day 3, transferred out of the pediatric intensive care unit on day 6, and discharged on postoperative day 11. Conclusions Strict perioperative management and early definitive surgery ensure satisfactory postoperative recovery. One-stage repair is safe and effective for suitable neonatal patients.

Study objective: This systematic review and network meta-analysis aimed to compare the effects of coffee consumption and gum chewing on postoperative bowel function recovery in patients undergoing colorectal surgery. Design: Systematic review and network meta-analysis of randomized controlled trials. Patients: Patients undergoing colorectal surgery. Interventions: Coffee consumption and gum chewing for postoperative bowel function recovery. Measurements: The primary outcomes included the time to first defecation and flatus postoperatively. Secondary outcomes comprised the time to first toleration of food, length of hospital stay, time to first feeling of hunger, postoperative opioid analgesic use, incidence of complications, postoperative ileus, anastomotic leakage, nausea, vomiting, and in-hospital mortality. Main results: Twenty-one studies involving 1536 patients were included. Six studies compared coffee consumption to a control group, while 15 studies compared gum chewing to a control group. Compared with control groups, coffee consumption significantly reduced the time to first defecation [mean difference (95% CI): −10.91 (−16.17, −5.65); I 2 = 43%; P < 0.0001] and flatus [mean difference (95% CI): −6.38 (−11.89, −0.87); I 2 = 0%; P = 0.02]. Similarly, gum chewing demonstrated significant reductions in time to first defecation [mean difference (95% CI): −17.83 (−22.60, −13.07); I 2 = 83%; P < 0.00001] and flatus [mean difference (95% CI): −13.71 (−17.88, −9.54); I 2 = 88%; P < 0.00001]. Network meta-analysis revealed a non-significant trend favoring gum chewing over coffee for these outcomes. Notably, gum chewing provided additional clinical benefits including reduced incidence of postoperative ileus and shorter hospitalization. In contrast, coffee showed superior effects in facilitating earlier oral intake and reducing postoperative opioid requirements. Both interventions exhibited comparable safety profiles with no significant differences in complication rates. Conclusions: This study demonstrates that both chewing gum and coffee consumption can promote postoperative bowel function recovery in patients undergoing colorectal surgery, with chewing gum appearing to yield superior outcomes. Both interventions were significantly more effective than standard care in reducing the time to first flatus and first defecation. Trial registration: PROSPERO identifier: CRD420251114493. The protocol can be accessed at PROSPERO.

Background: Albumin is a key protein essential for maintaining multiple physiological functions. During extracorporeal membrane oxygenation (ECMO) support, serum albumin concentration may decline as a result of hemodilution or capillary leakage. This reduction may be more pronounced in pediatric patients, whose hepatic synthetic function is not fully mature. However, evidence regarding the association between serum albumin concentration and clinical outcomes in pediatric postcardiotomy ECMO patients remains limited. This study aims to explore this association in pediatric patients. Methods: This single-center retrospective study included 96 pediatric patients who underwent venoarterial ECMO (VA-ECMO) after cardiac surgery. The association between nadir albumin concentration during ECMO and 30-day and 180-day mortality was explored using Cox regression model. Additionally, exploratory analyses were performed to assess the relationship between albumin concentration and ECMOrelated complications using logistic regression, aiming to further characterize potential factors associated with lower nadir albumin concentration and mortality. Subgroup and sensitivity analyses were performed to assess robustness. Results: In this study, the median age at ECMO initiation was 12.42 months [interquartile range (IQR): 6.42-40.06], with 64% being male. Overall, 30-day and 180-day mortality rates were 37.5% and 52.1%. Nadir albumin concentration was found to be inversely associated with the risk of 30-day [hazard ratio (HR): 0.924, 95% confidence interval (CI): 0.866-0.987] and 180-day mortality (HR: 0.929, 95% CI: 0.880-0.981). Exploratory analyses suggested no statistically significant associations between nadir albumin concentration and continuous renal replacement therapy (CRRT), hemolysis, thrombosis, major bleeding, and liver injury. Subgroup analyses showed no significant interactions by age, weight, or the Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery Congenital Heart Surgery (STAT) Mortality Categories. Sensitivity analyses restricted to patients with early nadir occurrence and excluding those without albumin supplementation yielded consistent results. Conclusions: In pediatric patients receiving postcardiotomy ECMO support, a lower nadir albumin concentration was independently correlated with an elevated risk of mortality and may serve as a readily available marker for risk stratification, warranting validation in prospective studies.

Background:Left ventricular assist device (LVAD) implantation is an effective destination therapy (DT) for patients ineligible for heart transplantation. While conventional median sternotomy (MS) is widely used, it involves significant surgical trauma, bleeding risk, and delayed recovery, potentially hindering rehabilitation. Minimally invasive (MI) techniques may reduce perioperative complications and enhance long-term quality of life. However, systematic comparisons between MI and MS approaches for LVAD implantation are limited, with scarce data from Chinese populations. This study compares perioperative outcomes, functional recovery, and health-related quality of life between these surgical approaches, providing high-level evidence to inform clinical practice. Methods:This study included 18 patients who underwent LVAD implantation (MI, n=12; MS, n=6). Preoperative characteristics, intraoperative metrics, postoperative recovery parameters, and complication rates were collected and compared between the two groups. Postoperative quality of life was evaluated with a comprehensive scale integrating generic health status, disease-specific symptoms, and device-related distress. Results:The MI group demonstrated superior perioperative outcomes. Intraoperative blood loss was reduced by nearly 50% (442.5±257.7 vs. 1,733.3±728.5 mL, P<0.001), and mechanical ventilation duration was shorter (5.25±4.33 vs. 27.00±27.18 days, P<0.001) compared to MS. Intensive care unit (ICU) and hospital stays were also shorter. The MI group showed improvements across multiple EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) dimensions, including overall health perception, usual activities, pain/discomfort, and body image distress (P<0.05). Conclusions:MI LVAD implantation is as safe as MS. It maintains equivalent cardiac improvement while offering faster recovery and enhanced postoperative quality of life.

Background: Corticosteroids are commonly used in neonatal cardiac surgery to reduce inflammation. Previous studies have shown that administering methylprednisolone (MP) during the perioperative period can reduce the inflammatory response. However, the impact of MP on postoperative clinical outcomes in neonates remains unclear. Thus, this study aimed to assess the effects of MP on postoperative inflammation and clinical outcomes in neonates undergoing cardiac surgery involving cardiopulmonary bypass (CPB).Methods: This was a prospective, non-randomized, unblinded, controlled trial in which the clinicians determined treatment assignment. A total of 86 neonates who underwent cardiac surgery with CPB between December 2020 and August 2023 were included. After induction of anesthesia, the MP group received a single dose of 30 mg/kg MP, while the placebo group received an equal volume of saline solution. Primary endpoints were plasma interleukin (IL-6, IL-8, and IL-10) and D-dimer concentrations. Composite outcomes included death, respiratory infection, cardiac arrest, need for extracorporeal membrane oxygenation, acute kidney injury, low cardiac output syndrome, and need for prolonged mechanical ventilation.Results: Consistent with the observed anti-inflammatory effects, MP administration was associated with significantly lower levels of proinflammatory cytokines (IL-6, IL-8) and higher levels of the anti-inflammatory cytokine (IL-10). MP did not significantly reduce the likelihood of the composite outcome (p = 0.664), with 25 patients (58.1%) in the MP group and 23 patients (53.5%) in the placebo group experiencing such outcomes. The MP group also showed a significantly lower postoperative vasoactive-inotropic score and higher postoperative procalcitonin levels and nadir mixed venous oxygen saturation during the first 24 hours. No significant differences in postoperative D-dimer, blood glucose, or insulin administration were observed between the two groups.Conclusions: Prophylactic administration of 30 mg/kg MP in neonates undergoing cardiac surgery with CPB did not result in a statistically significant improvement in clinical outcomes compared with placebo. However, this intervention was associated with a reduction in the inflammatory response.The Clinical Trial Registration: ChiCTR 2000040230, https://www.chictr.org.cn/showproj.html?proj=64716.

Pediatric cardiac surgery with cardiopulmonary bypass (CPB) carries substantial transfusion requirements, exposing patients to increased risks of complications during hospital stay. This study evaluates the clinical impact of a quality-controlled, multimodal blood conservation strategy during CPB in pediatric cardiac surgery. We collected the medical data of 9792 children (aged ≤ 14 years and weight > 10 kg) undergoing CPB cardiac surgery between September 2014 and December 2021. Since January 2016, the pediatric CPB center has implemented patient blood management. Subsequently, patients were divided into two groups: conventional management group (premanagement, n = 1762) and patient blood management group (postmanagement, n = 8030). Compare blood transfusion and outcomes. A 1:1 propensity score matching was performed. 1760 matched patient pairs were obtained. Compared with the premanagement group, the postmanagement group demonstrated significant reduction in packed red blood cell (PRBC) transfusion rates (during hospital stay: 38.1

Cardiac fibromas are rare benign primary tumors of the heart; nearly one-third of affected patients are less than 1 year old, and only 15

BACKGROUND:Thrombocytopenia is common for patients in the intensive care unit (ICU) and is associated with adverse outcomes. ICU thrombocytopenia in pediatric patients who underwent cardiac surgeries with cardiopulmonary bypass (CPB) is inadequately studied. OBJECTIVES:We aimed to investigate the incidence, risk factors, and prognostic role of ICU thrombocytopenia after congenital cardiac surgeries with CPB. METHODS:A retrospective study involving 11 761 patients was conducted. Patients were categorized into 4 groups of thrombocytopenia based on platelet counts tested during ICU: non (>150 × 109/L), mild (100-150 × 109/L), moderate (50-100 × 109/L), and severe (<50 × 109/L). Logistic and Cox regression analyses were utilized to explore the risk factors of thrombocytopenia and the association of ICU thrombocytopenia with 30-day mortality. RESULTS:ICU thrombocytopenia was observed in 4007 patients (34.1%), with mild, moderate, and severe thrombocytopenia occurring in 2773 (23.6%), 987 (8.4%), and 247 (2.1%) patients, respectively. Younger age, cyanotic congenital heart disease, CPB duration, and preoperative laboratory findings (red blood cell, thrombocytopenia, red cell distribution width, hematocrit, and coagulation disorder) were identified as independent risk factors of ICU thrombocytopenia. Patients with moderate (hazard ratio [95% CI]: 11.38 [3.02-42.87]; P < .001) and severe thrombocytopenia (hazard ratio [95% CI]: 49.54 [13.11-187.14]; P < .001) had a significantly higher risk of 30-day mortality. Furthermore, with the increase in the severity of ICU thrombocytopenia, there was an incremental increase in the incidence of postoperative critical bleeding and thrombosis, perioperative blood transfusions, length of ICU stays, and duration of mechanical ventilation. CONCLUSION:ICU thrombocytopenia occurred in one-third of children after congenital cardiac surgery with CPB, and it was associated with multiple adverse outcomes.

BACKGROUND: Preoperative liver function in children with congenital heart disease is often compromised to varying degrees because of the unique pathophysiology. We aimed to investigate the relationships between liver function indicators at hospital admission and mortality in children receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support following cardiac surgery. METHODS: We retrospectively analysed the clinical data of pediatric patients who received postcardiotomy VA-ECMO support at Fuwai Hospital between January 2010 and June 2020. Univariable and multivariable-adjusted Cox proportional hazard models were constructed to evaluate the risk factors associated with 30-day and 180-day mortality. The cut-off values for the liver function variables measured at hospital admission were categorized into high and low groups and then compared using Kaplan-Meier survival curves and log-rank tests. RESULTS: Our study included 96 pediatric patients who received VA-ECMO support after cardiotomy. Among the patients receiving VA-ECMO, the 30-day and 180-day mortality rates were 37.5% and 52.1%, respectively. The level of aspartate aminotransferase (AST) at admission was associated with 30-day mortality (hazard ratios [HRs]=1.852, 95%CI 1.010-3.398, P=0.046). The AST and alkaline phosphatase (ALP) levels were predictors of 180-day mortality, with adjusted HRs of 1.799 (95%CI 1.074-3.014; P=0.025) and 1.384 (95%CI 1.050-1.825; P=0.021), respectively. The cut-off value for AST to predict mortality at 30 d was 77 U/L, and that for ALP to predict mortality at 180 d was 269 U/L. CONCLUSION: Liver function indicators, including AST and ALP, at hospital admission are associated with mortality risk in children with congenital heart disease receiving VA-ECMO after cardiac surgery.

To guide clinical blood transfusion practices for pediatric patients, the National Health Commission has issued the health standard "Guideline for pediatric transfusion" (WS/T 795-2022). Blood transfusion is one of the most commonly used supportive treatments for children with hematological diseases. This guideline provides guidance and recommendations for blood transfusions in children with aplastic anemia, thalassemia, autoimmune hemolytic anemia, glucose-6-phosphate dehydrogenase deficiency, acute leukemia, myelodysplastic syndromes, immune thrombocytopenic purpura, and thrombotic thrombocytopenic purpura. This article presents the evidence and interpretation of the blood transfusion provisions for children with hematological diseases in the "Guideline for pediatric transfusion", aiming to assist in the understanding and implementing the blood transfusion section of this guideline.

To guide clinical blood transfusion practices for pediatric patients, the National Health Commission has issued the health standard "Guideline for pediatric transfusion" (WS/T 795-2022). Critically ill children often present with anemia and have a higher demand for transfusions compared to other pediatric patients. This guideline provides guidance and recommendations for blood transfusions in cases of general critical illness, septic shock, acute brain injury, extracorporeal membrane oxygenation, non-life-threatening bleeding, and hemorrhagic shock. This article interprets the background and evidence of the blood transfusion provisions for critically ill and severely bleeding children in the "Guideline for pediatric transfusion", aiming to enhance understanding and implementation of this aspect of the guidelines. Citation:Chinese Journal of Contemporary Pediatrics, 2025, 27(4): 395-403.

To guide clinical blood transfusion practices for pediatric patients, the National Health Commission has issued the health standard "Guideline for pediatric transfusion" (WS/T 795-2022). Blood transfusion for children undergoing hematopoietic stem cell transplantation is highly complex and challenging. This guideline provides recommendations on transfusion thresholds and the selection of blood components for these children. This article presents the evidence and interpretation of the transfusion provisions for children undergoing hematopoietic stem cell transplantation, with the aim of enhancing the understanding and implementation of the "Guideline for pediatric transfusion".

To guide clinical blood transfusion practices in pediatric patients, the National Health Commission has issued the health standard "Guideline for pediatric transfusion" (WS/T 795-2022). Children undergoing cardiac surgery are at high risk of bleeding, and the causes of perioperative anemia and coagulation disorders in neonates and children are complex and varied, often necessitating the transfusion of allogeneic blood components. This guideline provides direction and recommendations for specific measures in blood management for children undergoing cardiac surgery before, during, and after surgery. This article interprets the background and evidence for the formulation of the blood transfusion provisions for children undergoing cardiac surgery, hoping to facilitate the understanding and implementation of this guideline.

BACKGROUND:Timely recognition of perioperative red blood cell transfusion (PRT) risk is crucial for developing personalized blood management strategies in pediatric patients. In this study, we sought to construct a prediction model for PRT risk in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). METHODS:From September 2014 to December 2021, 23,884 pediatric patients under the age of 14 were randomly divided into training and testing cohorts at a 7:3 ratio. Variable selection was performed using univariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression. Multivariate logistic regression was then used to identify predictors, and a nomogram was developed to predict PRT risk. The model's performance was evaluated based on discrimination, calibration, and clinical utility in both cohorts. RESULTS:After multiple rounds of variable selection, eight predictors of PRT risk were identified: age, weight, preoperative hemoglobin levels, presence of cyanotic congenital heart disease, CPB duration, minimum rectal temperature during CPB, CPB priming volume, and the use of a small incision. The predictive model incorporating these variables demonstrated strong performance, with an area under the curve (AUC) of 0.886 (95% CI: 0.880-0.891) in the training cohort and 0.883 (95% CI: 0.875-0.892) in the testing cohort. The calibration plot closely aligned with the ideal diagonal line, and decision curve analysis indicated that the model provided a net clinical benefit. CONCLUSIONS:Our predictive model exhibits good performance in assessing PRT risk in pediatric patients undergoing cardiac surgery with CPB, providing clinicians a practical tool to optimize individualized perioperative blood management strategies for this vulnerable population.

To guide clinical blood transfusion practices for pediatric patients, the National Health Commission has issued the health standard "Guideline for pediatric transfusion" (WS/T 795-2022). Blood transfusion is one of the most commonly used supportive treatments for children with hematological diseases. This guideline provides guidance and recommendations for blood transfusions in children with aplastic anemia, thalassemia, autoimmune hemolytic anemia, glucose-6-phosphate dehydrogenase deficiency, acute leukemia, myelodysplastic syndromes, immune thrombocytopenic purpura, and thrombotic thrombocytopenic purpura. This article presents the evidence and interpretation of the blood transfusion provisions for children with hematological diseases in the "Guideline for pediatric transfusion", aiming to assist in the understanding and implementing the blood transfusion section of this guideline.

STUDY OBJECTIVE:This systematic review and network meta-analysis aimed to compare the effects of coffee consumption and gum chewing on postoperative bowel function recovery in patients undergoing cesarean sections. DESIGN:Systematic review and network meta-analysis of randomized controlled trials. PATIENTS:Patients undergoing cesarean section. INTERVENTIONS:Coffee consumption and gum chewing for postoperative bowel function recovery. MEASUREMENTS:The primary outcomes included the time to first defecation, first flatus, and first bowel sound postoperatively. Secondary outcomes comprised the time to first feeling of hunger, time to first toleration of food, length of hospital stay, incidence of complications, and patient satisfaction. MAIN RESULTS:Twenty studies involving 2876 patients were included. Four studies compared coffee consumption to a control group, while sixteen studies compared gum chewing to a control group. Compared to the control group, the coffee group demonstrated a significant reduction in the time to first defecation (mean difference [95% CI]: -4.4 [-5.97, -2.91]; I 2  = 39%; P < 0.00001) and the time to first flatus (mean difference [95% CI]: -4.59 [-5.67, -3.51]; I 2  = 48%; P < 0.00001). Similarly, the gum chewing group showed significant reductions compared to the control group in the time to first defecation (mean difference [95% CI]: -8.04 [-11.49, -4.58]; I 2  = 98%; P < 0.00001), first flatus (mean difference [95% CI]: -7.52 [-10.14, -4.90]; I 2  = 98%; P < 0.00001), and first bowel sound (mean difference [95% CI]: -4.67 [-7.29, -2.06]; I 2  = 99%; P < 0.00001). However, network meta-analysis revealed no significant differences between the coffee and gum chewing groups in these three outcomes. Additionally, coffee consumption significantly reduced the time to first toleration of food, whereas gum chewing did not shorten the time to first feeling of hunger or first toleration of food. Compared to the control group, gum chewing, but not coffee consumption, was associated with a shorter postoperative hospital stay. Furthermore, gum chewing reduced the incidence of complications and improved patient satisfaction. CONCLUSIONS:Gum chewing is more effective than coffee consumption in promoting postoperative bowel function recovery. However, both interventions are superior to the control group in reducing the time to first defecation and first flatus.

Background: Iron deficiency (ID) is linked to an increased need for perioperative red blood cell (RBC) transfusion in cardiac surgery. Traditional markers used to assess ID are often influenced by inflammation, whereas soluble transferrin receptor (sTfR) is less affected by inflammation. Therefore, the purpose of this study is to explore the relationship between sTfR levels and the need for high-volume RBC transfusion in pediatric cardiac surgery patients. Methods: From August 2021 to July 2022, 236 low-weight infants (<= 10 kg) who underwent cardiac surgery were included in this study. Preoperative sTfR levels and the volume of RBCs perioperatively transfused were recorded. Receiver operating characteristic (ROC) curve analysis and multivariable logistic model were used to explore the association between sTfR levels and the need for a high-volume of RBC transfusion in this study. Results: In our study, 29 (12.3%) patients received more than 2 units during the perioperative period. sTfR level was the most accurate marker for predicting the need for RBC transfusion [area under the curve (AUC) =0.643; 95% confidence interval (CI): 0.531-0.756]. Moreover, in both the continuous and categorical variable-adjusted models, a high sTfR level was associated with a greater need for RBC transfusion (P=0.006; P<0.001). Conclusions: RBC transfusion is common for low-weight infants undergoing cardiac surgery. Furthermore, a high preoperative sTfR level is associated with the need for a high-volume perioperative RBC transfusion.

IntroductionThe impact of non heparin-induced thrombocytopenia on the clinical outcomes for pediatric cardiac surgery patients who required veno-arterial extracorporeal membrane support (VA-ECMO) for failure to wean from cardiopulmonary bypass (CPB) is uncertain. This study aimed to investigate the relationship between thrombocytopenia and prognosis in these patients.MethodsThis retrospective study enrolled 96 pediatric patients (age < 18) who received VA-ECMO directly transitioned from CPB at Fuwai Hospital from January 2010 to June 2020. The association between relative decrease in platelet count (△PLT) post-ECMO 24 h and clinical outcomes was explored.ResultsThere were significant differences in Post-ECMO 24 h platelet counts, platelet count nadir, and duration of platelet decline between the survivors and non-survivors in CPB-ECMO groups. A positive correlation was found between △PLT post-ECMO 24 h and plasma-free hemoglobin (pFHb) (p = .014, r = 0.305), peak serum creatinine (p = .016, r = 0.299), peak AST (p = .014, r = 0.302), duration of platelet transfusion (p = .032, r = 0.270),The △PLT post-ECMO 24 h had predictive value on in-hospital mortality [(p < .001, AUROC = 0.781 (95% CI: 0.670-0.892)], massive bleeding (p = .001, AUROC 95% CI: 0.627-0.870), hemolysis (p = .046, AUROC 95% CI: 0.510-0.780), and nosocomial infection (p = .020, AUROC 95% CI: 0.536-0.801). Multivariate logistic regression showed that △PLT post-ECMO 24 h was associated with in-hospital mortality and hemolysis.ConclusionsThe relative early decrease in platelet count 24 h following transition to ECMO is associated with increased patient mortality, and is positively associated with adverse outcomes in pediatric cardiac surgery patients transferred from CPB to ECMO. Moreover, this decline rate can predict in-hospital survival, major bleeding, hemolysis, and hospital-acquired infections.