Risk Factors Associated With Allogenic Blood Transfusion in Primary Infant Cranial Vault Remodeling

Introduction: Cranial vault remodeling is commonly associated with high blood loss and high transfusion rates. Blood management protocols have recently been developed to minimize blood loss and reduce transfusion requirements. We sought to determine risk factors associated with blood product transfusion for infants undergoing primary cranial vault remodeling after the implementation of a blood management protocol. Methods: A retrospective review of patients who underwent cranial vault remodeling at a single center was performed. Patients under 18 months of age who underwent cranial vault remodeling after the establishment of a blood management protocol were included. Results: Thirty-five patients were identified. Eleven patients (31%) received allogenic blood transfusions. Patients who received allogenic blood transfusions had a lower absolute weight (8.8 kg versus 9.6kgP = 0.04), longer procedure times (337 minutes versus 275 minutesP < 0.01), and were more likely to have undergone fronto orbital advancement (91% versus 46%P = 0.02). There were no significant differences in age, weight percentile, and patient diagnosis between patients who received allogenic blood transfusions and those that did not (P > 0.05). Conclusion: Low weight, longer operative times, and fronto orbital advancement are associated with allogenic blood transfusion despite the use of a blood management protocol. Attempts to modify these factors may further improve outcomes.