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Associated Factors For Hyponatremia In Surgical Correction Of Craniosynostosis In Children
Michael Bykowski MS, Sanjay Naran MD, James Cray PhD, Erica Schmitt MD, Michael L. Moritz MD, Lorelei Grunwaldt MD, Franklyn Cladis MD, Joseph Losee MD
University of Pittsburgh
2010-03-10
Presenter: Michael Bykowski
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND:
Several case reports and small population-based studies have investigated peri-operative hyponatremia following calvarial vault remodeling (CVR) in children with craniosynostosis (CS). These studies highlighted the need for larger, more comprehensive studies.
OBJECTIVES:
1) To determine the incidence and severity of hyponatremia following CVR.
2) To identify potential risk factors to predict hyponatremia.
METHODS:
The database of a major metropolitan children's hospital was queried for medical records from patients who underwent CVR between 2003-2008. For each of 72 patient medical records, several pre-, intra-, and postoperative variables were analyzed.
RESULTS:
Of the 72 consecutive patients, 30.6% became hyponatremic postoperatively. The onset occurred most often on postoperative day 0 or 1 (p<0.05). Female gender is associated with hyponatremia in patients with normal preoperative ICP (relative risk= 2.43; p<0.05). Additionally, elevated preoperative ICP is associated with the development of hyponatremia (p<0.002).
Hyponatremia is associated with significantly more blood loss intraoperatively (p<0.007). Patients transfused with hypotonic solutions had a larger decrease in serum sodium compared to those transfused with isotonic solutions (p<0.04). While hospital stay was not significantly prolonged in hyponatremic patients, intensive care unit stay was significantly longer (p<0.005).
CONCLUSIONS:
Postoperative hyponatremia is an important source of potential morbidity in children who undergo CVR. We identified significant associations between hyponatremia and gender, volume of intraoperative blood loss, tonicity of transfused fluids, and elevated preoperative ICP. The identification of susceptible patients is useful to portend and prevent hyponatremia and its neurologic complications, as well as reducing ICU stay and associated health care costs.
