Cardiac surgery (neonates/infants) - most-studied population

• Bolus 30 mg/kg IV followed by an infusion of 10 mg/kg/h has been recommended for neonatal and pediatric cardiac surgery based on recent cardiac-surgery studies (lower loading doses are used in older patients) - Miller's Anesthesia, 10e.
• An older pediatric surgical trial (ages 2 months-6 years) used a 50 mg/kg loading dose followed by a 5 mg/kg/h infusion during surgery, reducing blood loss (65 vs 119 mL/kg) and transfusion needs.
• Because pharmacokinetic data in this age group are limited, there is "large variability in dosing methods used in different studies," and no single regimen is universally validated - Miller's Anesthesia, 10e.

Trauma (infants/children)

• Pragmatic pediatric trauma dosing (RCPCH/NPPG and TIC-TOC trial regimen): 15 mg/kg IV loading dose (max 1 g) over 10 minutes, followed by 2 mg/kg/h infusion for 8 hours.
• Broader ranges reported across studies: loading dose 10-30 mg/kg, maintenance infusion 5-10 mg/kg/h.
• Real-world median dose observed across 35,000+ pediatric hospital encounters was about 22.4 mg/kg.

Key safety/practical notes for infants

• Antifibrinolytics (TXA, aminocaproic acid) are used routinely in neonatal/pediatric cardiac surgery to reduce post-bypass bleeding, but aprotinin (an older alternative) is avoided in this age group due to safety concerns - Barash's Clinical Anesthesia, 9e.
• Neonates have an immature coagulation system (low antithrombin III, dysfunctional fetal fibrinogen, reduced platelet function) that matures over the first 3-6 months of life, which is part of why dosing extrapolated from adults is imprecise in this group.
• Renal impairment: TXA is renally excreted; dosing must be reduced in infants with renal dysfunction, and this population is poorly studied.
• High-dose risk: seizures have been reported with high TXA doses in children, so bolus doses should be given slowly (over ~10 minutes) and total daily doses kept within studied ranges.
• No dedicated, universally-agreed dosing exists for indications like epistaxis or minor mucosal bleeding in infants; adult topical/oral regimens are not validated for this age.

Bottom line practical ranges (weight-based, IV)