INTRODUCTION
Cardiac surgery with (CPB) is often associated with excessive blood loss, morbidity, early and late mortality, prolonged hospitalization, and costs. Outcome may further be worsened by the presence of pre-existing cofactors (e.g.anaemia), massive transfusion, and exploration for bleeding. Excessive blood loss often results from the development of a perioperative coagulopathy which can be triggered by several factors such as contact between blood and non-endothelial surfaces, anticoagulation using unfractioned heparin (UFH), protamine over dosage, and hypothermia.The cyanotic children might have decreased platelet aggregation, alteration in the fibrinogen activity, prolonged bleeding with normal platelet count, and even mild chronic disseminated intravascular coagulation (DIC). The severity of these hematologic alterations is directly related to the degree of polycythemia,a greater surgical complexity, degree of hypothermia, and heparin dosage.

AIM:
The aim of the present studywas to assess multiple risk factors for bleeding in postoperative pediatric cardiac surgery.


PATIENTS AND METHODS
The study included 100 cases admitted in Cardiothoracic Surgery Department, Alexandria Faculty of Medicine in New University Hospital, Alexandria, Egypt for congenital heart surgery.
The study was reviewing and comparing risk factors assessment for bleeding in postoperative pediatric cardiac surgery. A significant bleeding was defined as 84 mL/kg or more total for the first 12 hours postoperatively, or surgical exploration for bleeding or cardiac tamponade physiology in the first 12 hours.Univariate and multivariate logistic regression analyses were performed to determine variables independently associated with bleeding. These variables were used to calculate a probability for each individual to develop postoperative bleeding.