The Evaluation of Hematologic Screening and Perioperative Management in Patients with Noonan Syndrome: A Retrospective Chart Review

J Pediatr. 2020 May:220:154-158.e6. doi: 10.1016/j.jpeds.2020.01.048. Epub 2020 Feb 25.


Objectives: To assess the potential impact of using screening recommendations for bleeding disorders in patients with Noonan syndrome on perioperative bleeding complications.

Study design: We performed a retrospective, single-site cohort study; patients were identified by query of the electronic medical record. All patients with a clinical diagnosis of Noonan syndrome over a 10-year period were included. Data on surgeries, hematologic evaluation, bleeding symptoms, and bleeding complications were extracted. Surgeries were graded as major or minor.

Results: We identified 101 patients with Noonan syndrome, 70 of whom required surgery for a total of 164 procedures. Nine patients (9/70; 12.8%) had bleeding complications, occurring in those without comprehensive testing or perioperative intervention and undergoing major or dental surgery. Based on these findings, the risk of a bleeding complication for patients with Noonan syndrome who did not have comprehensive testing or perioperative intervention was 6.2% (95% CI 2.3%-10.1%), indicating the number needed to treat or screen would be 16 to prevent 1 bleeding complication (95% CI 9.9-43.9). The majority of patients had either no or incomplete evaluation (59 of 101; 58.4%).

Conclusions: With proper evaluation and management, the bleeding risk in patients with Noonan syndrome can be minimized. Efforts are needed to address the knowledge and implementation gap in this evaluation.

Keywords: bleeding disorders; screening recommendations.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Hemorrhage / etiology*
  • Hemorrhage / therapy*
  • Humans
  • Infant
  • Male
  • Mass Screening
  • Noonan Syndrome / complications*
  • Postoperative Hemorrhage / epidemiology
  • Postoperative Hemorrhage / prevention & control*
  • Preoperative Care*
  • Retrospective Studies
  • Surgical Procedures, Operative*
  • Young Adult