The impact of blood loss during cochlear implantation in very young children.

The aim of this study was to investigate if the intraoperative bleeding during cochlear implantation in very young children had any clinical importance and if it should influence the clinical management of such cases. A retrospective chart review of the pre- and postoperative hemoglobin concentration was performed on 14 implantations in children aged 16 months or younger at the time of surgery (11 males and 3 females). A postoperative decrease of the hemoglobin value was noted in 13 cases (93 %), with a mean difference between pre- and postoperative measurement of -1.9 g/dl. The most remarkable case was that of a 2-month-old newborn with a bilateral profound hearing loss caused by bacterial meningitis. In the course of the asynchronous bilateral cochlear implantation and due to a remarkable bleeding, a transfusion of packed red blood cells was performed. The increased loss of blood was reported at the time of detaching and lifting up the muscle-periosteal-flap from the mastoid bone as well as at the time of the mastoidectomy. The special physiological properties of this age can contribute to a rapid cardiovascular decompensation in the case of increased blood loss. The consideration of these aspects is of great importance in the stage of planning the cochlear implantation, which in this group of patients should include the requirement of banked human blood. In addition, the intraoperative bleeding should be taken into account during the decision for a simultaneous bilateral implantation.