Timing, Duration, and Severity of Hyponatremia Following Pediatric Brain Tumor Surgery*

Belzer, Jennifer S.; Williams, Cydni N.; Riva-Cambrin, Jay; Presson, Angela P.; Bratton, Susan L.

doi:10.1097/pcc.0000000000000154

Cited by 18 publications

(14 citation statements)

References 24 publications

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“…As rightly pointed out by Fante et al, we did not observe a statistically significant association between hyponatremia and seizures or hospital mortality (2). This is counter to what has been previously published by others (3–5). There are several reasons that could explain this difference.…”

contrasting

confidence: 99%

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Topjian

Friess

2015

Pediatric Critical Care Medicine

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contrasting

confidence: 99%

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Topjian

Friess

2015

Pediatric Critical Care Medicine

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“…In a recent study, hyponatremic children with intracranial neoplasms had a five-fold increased risk of moderate or severe disability based on their Pediatric Cerebral Performance Category score at discharge, with hyponatremia independently associated with worse neurologic outcome despite adjustment for age and tumor factors [68] . The same group also found an increased risk of postoperative hyponatremia after neurosurgery among children that was independent of the preoperative degree of hyponatremia [69] .…”

Section: Childrenmentioning

confidence: 77%

“…In the absence of severe or moderately severe symptoms, there is often sufficient time for diagnostic assessment and cause-specific treatment. Although children with severe hyponatremia need urgent, frequent and prolonged monitoring because of the risk of repeated sodium changes [69] , correction with hypertonic saline is not indicated in asymptomatic cases [88,89] . …”

Section: Correction Of Hyponatremiamentioning

confidence: 99%

Impact of perioperative hyponatremia in children: A narrative review

Andersen

Afshari

2014

WJCCM

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For more than 50 years, hypotonic fluids (crystalloids) have been the standard for maintenance fluid used in children. In the last decade, several studies have evaluated the risk of hyponatremia associated with the use of hypotonic vs isotonic fluids, which has lead to an intense debate. Children undergoing surgery have several stimuli for release of antidiuretic hormone, which controls renal water handling, including pain, nausea, vomiting, narcotic use and blood loss. The body's primary defense against the development of hyponatremia is the ability of the kidneys to excrete free water and dilute urine. Increased levels of antidiuretic hormone can result in hyponatremia, defined as a plasma sodium level < 136 mmol/L, which causes cells to draw in excess water and swell. This manifests as central nervous system symptoms such as lethargy, irritability and seizures. The risk for symptomatic hyponatremia is higher in children than in adults. It represents an emergency condition, and early diagnosis, prompt treatment and close monitoring are essential to reduce morbidity and mortality. The widespread use of hypotonic fluids in children undergoing surgery is a matter of concern and more focus on this topic is urgently needed. In this paper, we review the literature and describe the impact of perioperative hyponatremia in children. Key words: Children; Fluid; Hyponatremia; Pediatric; Perioperative Core tip: Hospital-acquired hyponatremia is common, particularly among children undergoing surgery. These children tend to develop hyponatremic encephalopathy at higher serum sodium concentrations than adults and they have a poorer prognosis. As the risk is increased by the use of hypotonic fluids, intraoperative fluids for children should be isotonic. Symptomatic hyponatremia should be corrected with 3% sodium chloride and close monitoring of the patient and serum sodium level is mandatory to prevent brain herniation and neurologic damage from cerebral ischemia.Andersen C, Afshari A. Impact of perioperative hyponatremia in children: A narrative review. World J Crit Care Med 2014; 3(4): 95-101 Available from:

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“…We have previously examined this cohort to report the incidence and risk factors for hyponatremia, the time course and severity of hyponatremia, and an exploratory association between serum sodium concentration ≤ 130 mEq/L and cognitive outcome. 4,31 In this study we sought to assess risk factors for worse cognitive outcome and the relationship between hyponatremia severity and cognitive outcome. Patient cognitive outcomes were measured by Pediatric Cerebral Performance Category (PCPC) scores assigned at the time of hospital discharge.…”

Section: Methods Study Populationmentioning

confidence: 99%

“…Hyponatremia following neurosurgical procedures in children with brain tumors is common, with mild sodium derangement occurring in half of the children 4 and severe sodium derangement occurring in approximately 12%. 4,30,31 In some clinical settings, hyponatremia is known to exacerbate cerebral edema and cause seizures and encephalopathy, which can contribute to secondary brain injury following neurosurgery. 19,26,28 Young age, hydrocephalus, malignant histology, and noncortical tumor location are important clinical risk factors for hyponatremia in the postoperative period among children with intracranial neoplasms.…”

mentioning

confidence: 99%

Hyponatremia and poor cognitive outcome following pediatric brain tumor surgery

Williams

Riva-Cambrin²,

Presson³

et al. 2015

PED

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OBJECT Pediatric intracranial neoplasms are common and cause substantial neurological morbidity. Postoperative hyponatremia is also common and may exacerbate neurological injury. The authors performed an exploratory analysis to evaluate an exposure-response relationship between hyponatremia severity and cognitive function at discharge. METHODS A retrospective cohort of patients 0–19 years old who underwent a first intracranial neoplasm surgery at a pediatric tertiary care hospital was reviewed. Outcome was assessed by Pediatric Cerebral Performance Category (PCPC) score of 1–6 at hospital discharge. Poor outcome was defined as PCPC score 3–6, corresponding to moderate or worse disability. RESULTS Of 319 total children, 80 (25%) had poor outcomes. One hundred thirty-seven children (43%) had serum sodium concentrations ≤ 131–135 mEq/L and 39 (12%) had serum sodium concentrations ≤ 130 mEq/L. Lower nadir sodium concentration and longer duration of hyponatremia were significantly associated with worsening PCPC score (p < 0.001). Rapid sodium decreases and more hyponatremic episodes were also significantly associated with worsening PCPC score (p < 0.001). After adjustment for patient factors, tumor characteristics, and measures of sodium disruption, multivariable analysis revealed noncortical tumor locations and lower nadir sodium concentration (adjusted odds ratio 0.86, 95% confidence interval 0.78–0.95) were important independent risk factors for poor cognitive outcome. CONCLUSIONS Neurocognitive disability and hyponatremia are common in children undergoing surgery for intracranial neoplasms. This study found a significant association between severity of hyponatremia and worsened cognitive outcome, with an apparent exposure-response relationship. These data support the need for careful postoperative monitoring of serum sodium. Further research is needed to determine if prevention and treatment of hyponatremia can improve outcomes in these children.

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Timing, Duration, and Severity of Hyponatremia Following Pediatric Brain Tumor Surgery*

Cited by 18 publications

References 24 publications

The authors reply

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Impact of perioperative hyponatremia in children: A narrative review

Hyponatremia and poor cognitive outcome following pediatric brain tumor surgery

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