Coagulopathy in neonatal surgery

Keywords: neonatal coagulopathy, neonatal surgery, necrotising enterocolitis, thrombocytosis, coagulopathy


Background: Neonatal patients planned for surgical intervention regularly await coagulation screening prior to surgical intervention. This study identified risk factors for coagulopathy in neonates undergoing surgical interventions to rationalise coagulation screening for patients in resource-restricted environments.

Methods: Records of neonates undergoing a surgical procedure at the study institution between June 2015 and September 2019 were reviewed. All patients younger than 44 weeks post conception were included. Age post delivery, congenital age, reason for surgery, procedure and coagulation screen and an inflammatory marker were recorded. The patients were stratified into categories for age and surgical intervention. The rate of abnormal coagulation screens was identified for the different age and diagnoses categories and correlations were calculated between these.

Results: Two hundred and fifty-three (of 313) patients had sufficient blood results to be analysed in the study. There was no significant difference between the rate of abnormal coagulation screen according to different age categories. The necrotising enterocolitis (NEC) group had the highest rate of abnormal international normalised ratio (INR) (55%) and platelet counts (46%). A notable finding was that patients with a platelet count of > 350 are up to six times less likely to have a raised INR.

Conclusion: This study shows that the rates of abnormal coagulation screens are higher in neonates with NEC compared with other diagnoses and patients with high platelet counts (> 350) are less likely to have an abnormal INR. This is useful in resource-restricted environments to inform decision making around omitting preoperative coagulation screening in select patients to avoid unnecessary theatre delays.

Author Biographies

P J Middleton, Stellenbosch University

Division of Paediatric Surgery, Tygerberg Hospital, Stellenbosch University, South Africa

O Pheiffer, George Provincial Hospital

George Provincial Hospital, South Africa

B Banieghbal, Stellenbosch University

Division of Paediatric Surgery, Tygerberg Hospital, Stellenbosch University, South Africa

How to Cite
Middleton, P., Pheiffer, O., & Banieghbal, B. (2022). Coagulopathy in neonatal surgery. South African Journal of Surgery, 60(3), S2-S5. Retrieved from
Paediatric Surgical Special Edition