Nucleated red blood cells after cardiopulmonary bypass in infants and children: is there a relationship to the systemic inflammatory response syndrome?

In a retrospective case control study we aimed to evaluate whether infants and children with nucleated red blood cells (NRBCs) in their peripheral blo od smears after cardiopulmonary bypass (CPB) had longer bypass limes than c ontrols without NRBCs. On review of a 3-year period, 58 children with NRBCs after CPB land without NRBCs prior to CPB) were identified (cases). A rand om sample of 100 children without NRBCs after CPB over the same period serv ed as controls. The median age (range) of the children with NRBCs and witho ut NRBCs was 0.6 years (2 days to 20 years) and 1.4 years (2 days to 16 yea rs), respectively (p = 0.03). The children with NRBCs had a significantly l onger bypass time than the controls (mean, standard deviation (SD): 114 min , 50 vs 79 min, 46 min; p < 0.0001). For the patients with postoperative po lychromasia alone. the mean CPB time(lll min, SD 46 min) was also significa ntly longer than the respective time in the controls (p < 0.001). Markers o f organ dysfunction (renal failure, use of inotropic support, time of endot racheal intubation, stay in intensive care unit and stay in hospital) were significantly more frequent/longer in the NRBC group. PostCPB release of NR BCs is associated with longer CPB time. This alteration may be part of the CPB-related systemic inflammatory response syndrome.